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General NPI Number Information
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NPI Number | 1679207302
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Entity Type | Individual
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Provider Name | OSAMA POTRES KESTO DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 07/09/2022
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Last Update Date | 07/09/2022
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Provider Practice Location Address
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Address Line | 22972 LAHSER RD STE 1
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4408
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Country | US
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Telephone | 248-864-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 37525 HACKER DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-4061
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Country | US
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Telephone | 586-565-0511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901601473
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License Number State | MI
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