Healthcare Provider Details

I. General information

NPI: 1003334046
Provider Name (Legal Business Name): JOMANA SHAYOTA KAMMO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30752 TELEGRAPH RD STE B
BINGHAM FARMS MI
48025-4523
US

IV. Provider business mailing address

30752 TELEGRAPH RD STE B
BINGHAM FARMS MI
48025-4523
US

V. Phone/Fax

Practice location:
  • Phone: 248-973-8102
  • Fax:
Mailing address:
  • Phone: 248-973-8102
  • Fax: 248-973-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901022363
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: