Provider Demographics
NPI:1679207302
Name:KESTO, OSAMA POTRES (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:POTRES
Last Name:KESTO
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:OSAMA
Other - Middle Name:IMAD
Other - Last Name:POTRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:37525 HACKER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4061
Mailing Address - Country:US
Mailing Address - Phone:586-565-0511
Mailing Address - Fax:
Practice Address - Street 1:22972 LAHSER RD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4408
Practice Address - Country:US
Practice Address - Phone:248-864-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist