Provider Demographics
NPI:1285847608
Name:OHLSON, THOMAS M (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:OHLSON
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 1:77 HALSEY DR
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1227
Mailing Address - Country:US
Mailing Address - Phone:203-637-2491
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist