# GREAT LAKES DENTISTRY SHELBY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Great Lakes Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871865832
- **Authorized official:** SHAWN VAN DE VYVER (PRESIDENT)
- **Authorized official phone:** (734) 320-8939

## Contact information

- **Practice address:** 53620 VAN DYKE AVE, SUITE 2, SHELBY TWP, MI 48316-1831
- **Practice address phone:** (586) 677-2828
- **Mailing address:** 73501 WINDMILL DR, BRUCE TWP, MI 48065-3159
- **Mailing address phone:** (734) 320-8939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901019702 | MI | Yes |

## Other

- **Enumeration date:** 02/06/2012
- **Last updated:** 01/25/2022