# ZOMA DENTAL PRACTICE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Zoma Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619582301
- **Authorized official:** DR. JACQUELINE ZOMA DDS (DENTIST)
- **Authorized official phone:** (248) 807-1420

## Contact information

- **Practice address:** 6330 ORCHARD LAKE RD STE 130, WEST BLOOMFIELD, MI 48322-2398
- **Practice address phone:** (248) 932-0550
- **Mailing address:** 6330 ORCHARD LAKE RD STE 130, WEST BLOOMFIELD, MI 48322-2398
- **Mailing address phone:** (248) 932-0550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 09/10/2020
- **Last updated:** 03/28/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1223G001X | DENTAL INSURANCE CARRIERS | MI |