Healthcare Provider Details

I. General information

NPI: 1003892944
Provider Name (Legal Business Name): JAMES J OSETEK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 BAY ST SUITE 2
PETOSKEY MI
49770-2489
US

IV. Provider business mailing address

322 BAY ST SUITE 2
PETOSKEY MI
49770-2489
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-1601
  • Fax: 231-347-0330
Mailing address:
  • Phone: 231-347-1601
  • Fax: 231-347-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberJO013255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: