Provider Demographics
NPI:1952387466
Name:OHLSSON, JAMES FREDERICK (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FREDERICK
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 1:115 INTERSTATE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2642
Mailing Address - Country:US
Mailing Address - Phone:423-479-6005
Mailing Address - Fax:
Practice Address - Street 1:115 INTERSTATE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2642
Practice Address - Country:US
Practice Address - Phone:423-479-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist