Provider Demographics
NPI:1558465971
Name:KENNEBREW HORTON, SHELIA YVETTE (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:SHELIA
Middle Name:YVETTE
Last Name:KENNEBREW HORTON
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29556 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2021
Mailing Address - Country:US
Mailing Address - Phone:248-552-1195
Mailing Address - Fax:248-552-0980
Practice Address - Street 1:29556 SOUTHFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2021
Practice Address - Country:US
Practice Address - Phone:248-552-1195
Practice Address - Fax:248-552-0980
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010152961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics