| NPI | 1083003222 |
|---|---|
| Doing Business As | GREAT LAKES DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SHAWN VAN DE VYVER President 734-320-8939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019702) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2020-02-19 |