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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