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Organization
GREAT LAKES DENTISTRY CHESTERFIELD
Active
Organization
GREAT LAKES DENTISTRY CHESTERFIELD
Active
Other names
Great Lakes Dental Excellence
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN VAN DE VYVER (MANAGER)
(734) 320-8939
Entity
Organization
Contact information
Practice address
34301 23 MILE RD STE 140A, CHESTERFIELD, MI 48047-4432
(586) 725-5500
Mailing address
73501 WINDMILL DR, BRUCE TWP, MI 48065-3159
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/25/2022
Last updated
01/25/2022
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