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Organization
VAN DE VYVER DENTAL, P.C.
Active
Organization
VAN DE VYVER DENTAL, P.C.
Active
Other names
Great Lakes Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN VAN DE VYVER DDS (PRESIDENT)
(734) 320-8939
Entity
Organization
Contact information
Practice address
53620 VAN DYKE AVE STE 2, SHELBY TOWNSHIP, MI 48316-1831
(586) 677-2828
Mailing address
53620 VAN DYKE AVE STE 2, SHELBY TOWNSHIP, MI 48316-1831
(586) 677-2828
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901019702
MI
Other
Enumeration date
01/12/2015
Last updated
02/19/2020
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