| NPI | 1871865832 |
|---|---|
| Doing Business As | GREAT LAKES DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SHAWN VAN DE VYVER President 734-320-8939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901019702) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2022-01-25 |