Healthcare Provider Details

I. General information

NPI: 1427227297
Provider Name (Legal Business Name): DOUGLAS RAINES SEWELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S COLORADO BLVD
GLENDALE CO
80246-3003
US

IV. Provider business mailing address

1100 S. COLORADO BLVD
GLENDALE CO
80246
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-0575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDSO36948
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10670
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: