Provider Demographics
NPI:1780746230
Name:DAHLSTEN, JOHN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:DAHLSTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 PONDVIEW PL APT 102
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3050
Mailing Address - Country:US
Mailing Address - Phone:513-561-2974
Mailing Address - Fax:
Practice Address - Street 1:2595 NEEDMORE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4203
Practice Address - Country:US
Practice Address - Phone:937-277-3442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.078014207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC83436Medicare UPIN