Healthcare Provider Details

I. General information

NPI: 1124053376
Provider Name (Legal Business Name): DONALD P OHLSSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD SUITE 204
ROCHESTER MI
48309
US

IV. Provider business mailing address

1460 WALTON BLVD SUITE 204
ROCHESTER MI
48309
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-1613
  • Fax: 248-651-1632
Mailing address:
  • Phone: 248-651-1613
  • Fax: 248-651-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901014453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: