Healthcare Provider Details

I. General information

NPI: 1568075786
Provider Name (Legal Business Name): D & J DENTAL HOLDINGS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 WEALTHY ST SE STE 100
GRAND RAPIDS MI
49506-3055
US

IV. Provider business mailing address

2249 WEALTHY ST SE STE 100
GRAND RAPIDS MI
49506-3055
US

V. Phone/Fax

Practice location:
  • Phone: 616-454-8228
  • Fax:
Mailing address:
  • Phone: 616-454-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ALFRED OSTROWSKI
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 616-292-7733