Provider Demographics
NPI:1811500036
Name:JACK OSTROWSKI DDS PLLC
Entity type:Organization
Organization Name:JACK OSTROWSKI DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:OSTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-292-7733
Mailing Address - Street 1:2186 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-8637
Mailing Address - Country:US
Mailing Address - Phone:616-897-8491
Mailing Address - Fax:
Practice Address - Street 1:2186 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8637
Practice Address - Country:US
Practice Address - Phone:616-897-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental