Healthcare Provider Details

I. General information

NPI: 1285847608
Provider Name (Legal Business Name): THOMAS M OHLSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 3RD ST
STAMFORD CT
06905-5100
US

IV. Provider business mailing address

77 HALSEY DR
OLD GREENWICH CT
06870-1227
US

V. Phone/Fax

Practice location:
  • Phone: 203-359-3296
  • Fax: 203-327-0019
Mailing address:
  • Phone: 203-637-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4805
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: