Provider Demographics
NPI:1124486675
Name:BOSWELL, COLIN (DDS)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6934
Mailing Address - Country:US
Mailing Address - Phone:641-780-7792
Mailing Address - Fax:
Practice Address - Street 1:9119 W 74TH ST STE 210
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2229
Practice Address - Country:US
Practice Address - Phone:913-648-2266
Practice Address - Fax:913-768-1944
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS613561223G0001X, 1223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty