Great Lakes Dentistry Shelby

Primary specialty

DentistTaxonomy code 122300000X

License

2901019702 Issued in MI

Legal business name

GREAT LAKES DENTISTRY SHELBY

Doing business as

Great Lakes Dentistry

Practice address

53620 Van Dyke Ave
Suite 2
Shelby TWP, MI 48316-1831

Phone

(586) 677-2828

NPI assigned

Feb 6, 2012

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

President

Phone

(734) 320-8939

Specialties & licenses 1

Addresses

Other names 1

• Great Lakes Dentistry Doing business as

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": "1328486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1871865832",
    "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",
            "address_2": "SUITE 2",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483161831",
            "telephone_number": "586-677-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DENTISTRY SHELBY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-06",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "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"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Gjokaj, DDS
• Gods Care LLC
• Theresa Ann Goike, PT
• Reanna Golab, LMT
• Marsha Donnita Gordon, MA
• Nicole Griffith, LPC
• Chris Groulx, COTAL
• Lovell I Guanco, MD
• Allison Haines, DPT
• Paris Hale-Johnson

• Dentist in Shelby TWP, MI
• Providers in Shelby TWP, 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.