Provider Demographics
NPI:1891499562
Name:ZOMA DENTAL FARMINGTON PLLC
Entity Type:Organization
Organization Name:ZOMA DENTAL FARMINGTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZOMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-925-2054
Mailing Address - Street 1:33776 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2269
Mailing Address - Country:US
Mailing Address - Phone:248-925-2054
Mailing Address - Fax:
Practice Address - Street 1:33211 GRAND RIVER AVE STE 23
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-6403
Practice Address - Country:US
Practice Address - Phone:248-925-2054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty