Provider Demographics
NPI:1427338797
Name:AHLSTROM, ALVIN H L (RDH)
Entity type:Individual
Prefix:MRS
First Name:ALVIN
Middle Name:H L
Last Name:AHLSTROM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-9591
Mailing Address - Country:US
Mailing Address - Phone:541-472-9354
Mailing Address - Fax:
Practice Address - Street 1:1201 NE 7TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1451
Practice Address - Country:US
Practice Address - Phone:541-479-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3579124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist