Provider Demographics
NPI:1710378211
Name:JOUJA, DIORA CHRISTINA (DDS)
Entity Type:Individual
Prefix:
First Name:DIORA
Middle Name:CHRISTINA
Last Name:JOUJA
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 1:1665 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2121
Mailing Address - Country:US
Mailing Address - Phone:248-547-7700
Mailing Address - Fax:
Practice Address - Street 1:1665 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2121
Practice Address - Country:US
Practice Address - Phone:485-547-7700
Practice Address - Fax:248-547-6054
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710378211Medicaid