Great Lakes Dentistry Chesterfield
NPI #1073265542 in Chesterfield, Michigan
Provider Information
- NPI Number
- 1073265542
- Entity Type
- Organization
- Organization Name
- Great Lakes Dentistry Chesterfield
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Jan 25, 2022
- Last Updated
- Jan 25, 2022
Practice Location
- Address
- 34301 23 MILE RD STE 140A
- City
- Chesterfield
- State
- Michigan
- ZIP Code
- 48047-4432
- Phone
- (586) 725-5500
Authorized Official
- Name
- DR. SHAWN VAN DE VYVER
- Title
- MANAGER
- Phone
- (734) 320-8939
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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