Van de Vyver Dental, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901019702 Issued in MI

Legal business name

VAN DE VYVER DENTAL, P.C.

Practice address

53620 Van Dyke Ave Ste 2
Shelby Township, MI 48316-1831

Phone

(586) 677-2828

NPI assigned

Jan 12, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shawn Van de Vyver, DDSNPI 1548309644

Title

President

Phone

(734) 320-8939

Specialties & licenses 1

Addresses

Other names 1

• Great Lakes Dentistry Doing business as

Tax ID family

Great Lakes Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Van de Vyver Dental, P.C.

  • Dental Clinic/Center
  • Roseville, MI
  • NPI 1346873288
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn Thomas Van de Vyver, DDS

  • Dentist
  • Shelby Township, MI
  • NPI 1548309644
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1083003222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53620 VAN DYKE AVE STE 2",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483161831",
            "telephone_number": "586-677-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53620 VAN DYKE AVE STE 2",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483161831",
            "telephone_number": "586-677-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN DE VYVER DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-12",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "VAN DE VYVER",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-320-8939",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Lakes Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Uzma Rehman DO PC
• Talli Lynn Vadnais, PTA
• John Vincent Valeri, DDS
• Shannon Valicevic
• Larry Van Ameyde, DDS
• Shawn Thomas Van de Vyver, DDS
• Kathleen P Vani, DDS PLLC
• Hailey Vansen, DC
• Zachary Vansen, D.C
• Paul S Vanwalleghem, DDS

• General Practice Dentistry in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.