Healthcare Provider Details

I. General information

NPI: 1063497907
Provider Name (Legal Business Name): JAMES JOHN OSTROMECKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 PLEASANT ST
SPENCER MA
01562-1626
US

IV. Provider business mailing address

48 PLEASANT ST
SPENCER MA
01562
US

V. Phone/Fax

Practice location:
  • Phone: 508-885-6366
  • Fax: 508-885-2380
Mailing address:
  • Phone: 508-885-6366
  • Fax: 508-885-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17730
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: