Healthcare Provider Details

I. General information

NPI: 1124935564
Provider Name (Legal Business Name): JENCY SHAJI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 W PIERSON RD
FLUSHING MI
48433-2338
US

IV. Provider business mailing address

6221 W PIERSON RD
FLUSHING MI
48433-2338
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-2700
  • Fax:
Mailing address:
  • Phone: 810-733-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603190
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: