| NPI | 1073265542 |
|---|---|
| Doing Business As | GREAT LAKES DENTAL EXCELLENCE |
| Entity Type | Organization |
| Authorized Contact | SHAWN VAN DE VYVER Manager 734-320-8939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2022-01-25 |