NPIMap

Organization Active NPI

Kennedy Marzonie Gray & Associates PLLC

  • Dentist
  • Ann Arbor, MI
National Provider Identifier
1154430718
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
18447 Issued in MI
Legal business name
KENNEDY MARZONIE GRAY & ASSOCIATES PLLC
Practice address
2365 S Huron Pkwy
Ann Arbor, MI 48104-5156
Phone
(734) 677-8700
Fax
(348) 394-1377
NPI assigned
Aug 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sharene Nicole Rumohr
Title
Billing and Marketing Manager
Phone
(734) 677-8700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 12814 MI
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 12824 MI
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 18447 MI Primary

Addresses

Primary practice location

2365 S Huron Pkwy
Ann Arbor, MI 48104-5156

Mailing address

2365 S Huron Pkwy
Ann Arbor, MI 48104-5156
Phone (734) 677-8700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131031001073 MI DME Supplier - Oral Surgery - Dentist 0345475257 Practice locations: Ann Arbor, MI

National Provider Directory

National Provider Directory
Tax ID family
Apnea Alternatives2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2900 Golfside Dr
Ste 6
Ann Arbor, MI 48108
Phone (734) 224-9121

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659312000000",
    "number": "1154430718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2365 S HURON PKWY",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045156",
            "telephone_number": "734-677-8700",
            "fax_number": "734-839-4137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 S HURON PKWY",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045156",
            "telephone_number": "734-677-8700",
            "fax_number": "348-394-1377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY MARZONIE GRAY & ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "RUMOHR",
        "authorized_official_first_name": "SHARENE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "BILLING AND MARKETING MANAGER",
        "authorized_official_telephone_number": "734-677-8700"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "12814",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "12824",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "18447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.