Great Lakes Dentistry Shelby

NPI #1871865832 in Shelby Twp, Michigan

Provider Information

NPI Number: 1871865832
Entity Type: Organization
Organization Name: Great Lakes Dentistry Shelby
Primary Specialty: Dentist
Enumeration Date: Feb 6, 2012
Last Updated: Jan 25, 2022

Practice Location

Address: 53620 VAN DYKE AVE
Address 2: SUITE 2
City: Shelby Twp
State: Michigan
ZIP Code: 48316-1831
Phone: (586) 677-2828

Authorized Official

Name: SHAWN VAN DE VYVER
Title: PRESIDENT
Phone: (734) 320-8939

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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