Provider Demographics
NPI:1003892944
Name:OSETEK, JAMES J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:OSETEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 BAY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2489
Mailing Address - Country:US
Mailing Address - Phone:231-347-1601
Mailing Address - Fax:231-347-0330
Practice Address - Street 1:322 BAY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2489
Practice Address - Country:US
Practice Address - Phone:231-347-1601
Practice Address - Fax:231-347-0330
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJO0132551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJO013255OtherDENTAL LICENSE
1154483014OtherNPI ORGANIZATION
MI2773425Medicaid
MI2773434Medicaid
MI3020517Medicaid
MI0B46032OtherBCBSM PROVIDER ID
MI3020526Medicaid
MI3020526Medicaid
MI3020526Medicaid
MIU23066Medicare UPIN