Individual
DR. SHAWN THOMAS VAN DE VYVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
53620 VAN DYKE AVE STE 2, SHELBY TOWNSHIP, 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
22687
TX
122300000X
Dentist
Primary
2901019702
MI
1223D0001X
Public Health Dentistry
2901019702
MI
Other
Enumeration date
02/05/2007
Last updated
01/25/2022
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