Shelia Y Kennebrew DDS., Ms., PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D2901015296 Issued in MI

Legal business name

SHELIA Y KENNEBREW DDS., MS., PC

Practice address

29556 Southfield Rd
Suite 100
Southfield, MI 48076-2021

Phone

(248) 552-1195

Fax

(248) 552-0980

NPI assigned

Sep 15, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Shelia Yvette Kennebrew Horton, DDS., MS

Title

Periodontist/Owner

Phone

(248) 552-1195

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1689043192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29556 SOUTHFIELD RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762021",
            "telephone_number": "248-552-1195",
            "fax_number": "248-552-0980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29556 SOUTHFIELD RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762021",
            "telephone_number": "248-552-1195",
            "fax_number": "248-552-0980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELIA Y KENNEBREW DDS., MS., PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "KENNEBREW HORTON",
        "authorized_official_first_name": "SHELIA",
        "authorized_official_middle_name": "YVETTE",
        "authorized_official_title_or_position": "PERIODONTIST/OWNER",
        "authorized_official_telephone_number": "248-552-1195",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS., MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "D2901015296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Southfield, MI
• Providers in Southfield, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.