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General NPI Number Information
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NPI Number | 1427338797
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Entity Type | Individual
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Provider Name | ALVIN H. L. AHLSTROM RDH
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Gender | Female
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 1201 NE 7TH ST SUITE E
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City | GRANTS PASS
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State | OR
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Zip | 97526-1451
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Country | US
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Telephone | 541-479-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 5713 FISH HATCHERY RD
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City | GRANTS PASS
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State | OR
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Zip | 97527-9591
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Country | US
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Telephone | 541-472-9354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H3579
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License Number State | OR
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