Provider Demographics
NPI:1518085521
Name:DAHLSTROM, FRANK ALDEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ALDEN
Last Name:DAHLSTROM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MAIN ST.
Mailing Address - Street 2:P O BOX 985
Mailing Address - City:DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02638-0985
Mailing Address - Country:US
Mailing Address - Phone:508-385-3136
Mailing Address - Fax:508-385-3137
Practice Address - Street 1:811 MAIN ST.
Practice Address - Street 2:
Practice Address - City:DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02638-0985
Practice Address - Country:US
Practice Address - Phone:508-385-3136
Practice Address - Fax:508-385-3137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice