# DWIGHT J MONSMA DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972679504
- **Authorized official:** MS. EWA BARBARA OSTROWSKI (BUSINESS ADMINISTRATOR)
- **Authorized official phone:** (616) 942-9891

## Contact information

- **Practice address:** 3521 LAKE EASTBROOK BLVD SE, GRAND RAPIDS, MI 49546
- **Practice address phone:** (616) 942-9891
- **Practice address fax:** (616) 942-9891
- **Mailing address:** 3521 LAKE EASTBROOK BLVD SE, GRAND RAPIDS, MI 49546
- **Mailing address phone:** (616) 942-9891
- **Mailing address fax:** (616) 942-9894

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901008106 | MI | Yes |

## Other

- **Enumeration date:** 11/27/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4063994 | — | MI |