Provider Demographics
NPI:1659454114
Name:KENNEDY, DEBRA KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:KAY
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 FELLOWS HILL CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6349
Mailing Address - Country:US
Mailing Address - Phone:734-455-3554
Mailing Address - Fax:
Practice Address - Street 1:2355 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1550
Practice Address - Country:US
Practice Address - Phone:248-547-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI158241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice