Provider Demographics
NPI:1154430718
Name:KENNEDY MARZONIE GRAY & ASSOCIATES PLLC
Entity type:Organization
Organization Name:KENNEDY MARZONIE GRAY & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND MARKETING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARENE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:RUMOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-677-8700
Mailing Address - Street 1:2365 S HURON PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5156
Mailing Address - Country:US
Mailing Address - Phone:734-677-8700
Mailing Address - Fax:734-839-4137
Practice Address - Street 1:2365 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5156
Practice Address - Country:US
Practice Address - Phone:734-677-8700
Practice Address - Fax:348-394-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12814122300000X
MI12824122300000X
MI18447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty