Provider Demographics
NPI:1225567340
Name:MOMIN, SHALOMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHALOMI
Middle Name:
Last Name:MOMIN
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 1:2664 OLDE IVY LN
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5776
Mailing Address - Country:US
Mailing Address - Phone:770-761-0129
Mailing Address - Fax:
Practice Address - Street 1:5350 HARVEY ST STE D
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-6725
Practice Address - Country:US
Practice Address - Phone:231-638-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice