MEDICARE: DR. KENYA MICHELLE MCCALEBB D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	100123115	WI

General Provider Information

NPI Number	:	1295182285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENYA MICHELLE MCCALEBB D.D.S.

Provider Business Mailing Address
First Line	:	1550 N EDISON ST
Second Line	:	APARTMENT 205
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3166
Country	:	US
Telephone Number	:	773-587-6182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 N EDISON ST
Second Line	:	APARTMENT 205
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3166
Country	:	US
Telephone Number	:	773-587-6182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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