Healthcare Provider Details

I. General information

NPI: 1336668367
Provider Name (Legal Business Name): MARTA OSTROMECKI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 N PORT WASHINGTON RD
MEQUON WI
53092-3465
US

IV. Provider business mailing address

11501 N PORT WASHINGTON RD
MEQUON WI
53092-3465
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-8880
  • Fax:
Mailing address:
  • Phone: 262-241-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019031215
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: