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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