Healthcare Provider Details

I. General information

NPI: 1972391761
Provider Name (Legal Business Name): DENTISTRY BY THE DAM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7166 S CROTON HARDY DR
NEWAYGO MI
49337-7707
US

IV. Provider business mailing address

1728 TAMARACK AVE NW
GRAND RAPIDS MI
49504-2849
US

V. Phone/Fax

Practice location:
  • Phone: 231-652-1663
  • Fax:
Mailing address:
  • Phone: 616-648-5608
  • Fax: 616-648-5608

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 A OSTROWSKI
Title or Position: OWNER
Credential: DDS
Phone: 616-648-5608