| Great Lakes Dentistry | |
|
53620 Van Dyke Ave Ste 2 Shelby Township MI 48316-1831 | |
| (586) 677-2828 | |
| Not Available |
| Full Name | Great Lakes Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 53620 Van Dyke Ave Ste 2, Shelby Township, Michigan |
| Authorized Official Name and Position | Shawn Van De Vyver (PRESIDENT) |
| Authorized Official Contact | 7343208939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Dentistry 53620 Van Dyke Ave Ste 2 Shelby Township MI 48316-1831 Ph: (586) 677-2828 | Great Lakes Dentistry 53620 Van Dyke Ave Ste 2 Shelby Township MI 48316-1831 Ph: (586) 677-2828 |
| NPI Number | 1083003222 |
|---|---|
| Provider Enumeration Date | 01/12/2015 |
| Last Update Date | 02/19/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083003222 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2901019702 (Michigan) | Primary |
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