Shawn Thomas Van de Vyver, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901019702 Issued in MI

Practice address

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

Phone

(586) 677-2828

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Great Lakes Dentistry Shelby

  dba Great Lakes Dentistry

  • Dentist
  • Shelby TWP, MI
  • NPI 1871865832
  NPD Authorized official
• Van de Vyver Dental, P.C.

  dba Great Lakes Dentistry

  • General Practice Dentistry
  • Shelby Township, MI
  • NPI 1083003222
  NPD Authorized official
• Van de Vyver Dental, P.C.

  • Dental Clinic/Center
  • Roseville, MI
  • NPI 1346873288
  NPD Authorized official
• Great Lakes Dentistry Chesterfield

  dba Great Lakes Dental Excellence

  • Dental Clinic/Center
  • Chesterfield, MI
  • NPI 1073265542
  Authorized official Same address or phone
• Kelly Road Dentistry PLLC

  • Dental Clinic/Center
  • Roseville, MI
  • NPI 1558254433
  NPD (past)
• Lala Smiles Dentistry PC

  • Dental Clinic/Center
  • Royal Oak, MI
  • NPI 1871096404
  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1548309644",
    "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": "734-320-8939"
        },
        {
            "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": [
        {
            "address_1": "34301 23 Mile Rd Ste 140A",
            "address_purpose": "LOCATION",
            "city": "Chesterfield",
            "state": "MI",
            "postal_code": "480474432",
            "country_code": "US",
            "telephone_number": "586-725-5500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25810 Kelly Rd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "MI",
            "postal_code": "480664467",
            "country_code": "US",
            "telephone_number": "586-775-4260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN DE VYVER",
        "first_name": "SHAWN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "22687",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "MI",
            "license": "2901019702",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Talli Lynn Vadnais, PTA
• John Vincent Valeri, DDS
• Shannon Valicevic
• Larry Van Ameyde, DDS
• Van de Vyver Dental, P.C. (Great Lakes Dentistry)
• Kathleen P Vani, DDS PLLC
• Hailey Vansen, DC
• Zachary Vansen, D.C
• Paul S Vanwalleghem, DDS
• Michelle Vasille

• Dentist in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.