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Organization
GREAT LAKES DENTISTRY SHELBY
Active
Organization
GREAT LAKES DENTISTRY SHELBY
Active
Other names
Great Lakes Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN VAN DE VYVER (PRESIDENT)
(734) 320-8939
Entity
Organization
Contact information
Practice address
53620 VAN DYKE AVE, SUITE 2, SHELBY TWP, MI 48316-1831
(586) 677-2828
Mailing address
73501 WINDMILL DR, BRUCE TWP, MI 48065-3159
(734) 320-8939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901019702
MI
Other
Enumeration date
02/06/2012
Last updated
01/25/2022
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