Healthcare Provider Details

I. General information

NPI: 1891499562
Provider Name (Legal Business Name): ZOMA DENTAL FARMINGTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33211 GRAND RIVER AVE STE 23
FARMINGTON MI
48336-6403
US

IV. Provider business mailing address

33776 VISTA DR
FARMINGTON HILLS MI
48331-2269
US

V. Phone/Fax

Practice location:
  • Phone: 248-925-2054
  • Fax:
Mailing address:
  • Phone: 248-925-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE J ZOMA
Title or Position: DENTIST
Credential: DDS
Phone: 248-925-2054