Healthcare Provider Details

I. General information

NPI: 1760281844
Provider Name (Legal Business Name): ANGELA SEWELL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MARIE SPELL

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 VILLAGE DR
PAGOSA SPRINGS CO
81147-8368
US

IV. Provider business mailing address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

V. Phone/Fax

Practice location:
  • Phone: 970-264-2104
  • Fax:
Mailing address:
  • Phone: 970-335-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002026082
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: