Provider Demographics
NPI:1053524470
Name:THOMAS M OHLSON DDS & ASSOC. PC
Entity type:Organization
Organization Name:THOMAS M OHLSON DDS & ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:OHLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-359-3296
Mailing Address - Street 1:25 3RD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5100
Mailing Address - Country:US
Mailing Address - Phone:203-359-3296
Mailing Address - Fax:203-327-0019
Practice Address - Street 1:25 3RD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5100
Practice Address - Country:US
Practice Address - Phone:203-359-3296
Practice Address - Fax:203-327-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty