Van de Vyver Dental, P.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

VAN DE VYVER DENTAL, P.C.

Practice address

25810 Kelly Rd Ste 2
Roseville, MI 48066-4467

Phone

(734) 320-8939

NPI assigned

Feb 19, 2020

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 VyverNPI 1548309644

Title

Dentist

Phone

(734) 320-8939

Specialties & licenses 1

Addresses

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.

  • General Practice Dentistry
  • Shelby Township, MI
  • NPI 1083003222
  NPD tax ID

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": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1346873288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73501 WINDMILL DR",
            "city": "BRUCE TWP",
            "state": "MI",
            "postal_code": "480653159",
            "telephone_number": "586-372-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25810 KELLY RD STE 2",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664467",
            "telephone_number": "734-320-8939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN DE VYVER DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "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": "DENTIST",
        "authorized_official_telephone_number": "734-320-8939"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Roseville, MI
• Providers in Roseville, MI by specialty
• Dental Clinic/Center 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.