Provider Demographics
NPI:1003334046
Name:SHAYOTA, JOMANA S (DDS)
Entity Type:Individual
Prefix:
First Name:JOMANA
Middle Name:S
Last Name:SHAYOTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32749 FRANKLIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1122
Mailing Address - Country:US
Mailing Address - Phone:248-973-8102
Mailing Address - Fax:248-973-8061
Practice Address - Street 1:32749 FRANKLIN RD STE 200
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1122
Practice Address - Country:US
Practice Address - Phone:248-973-8102
Practice Address - Fax:248-973-8061
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306583943Medicaid