Healthcare Provider Details

I. General information

NPI: 1538501887
Provider Name (Legal Business Name): SHELLEY SUZANNE ZOLMAN D. D. S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

1365 INDIAN MOUND W
BLOOMFIELD HILLS MI
48301-2263
US

V. Phone/Fax

Practice location:
  • Phone: 313-494-6780
  • Fax:
Mailing address:
  • Phone: 248-792-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: