Provider Demographics
NPI:1124053376
Name:OHLSSON, DONALD P (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:OHLSSON
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 1:1460 WALTON BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48309
Mailing Address - Country:US
Mailing Address - Phone:248-651-1613
Mailing Address - Fax:248-651-1632
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48309
Practice Address - Country:US
Practice Address - Phone:248-651-1613
Practice Address - Fax:248-651-1632
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
975210OtherUNITED CONCORDIA
MI3516128Medicaid