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General NPI Number Information
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NPI Number | 1053669648
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Entity Type | Organization
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Legal Business Name | ADVANCE DENTAL, P.C.
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 242 WEST VALLEY AVENUE SUITE 101
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3635
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Country | US
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Telephone | 205-290-7878
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Fax | 205-290-7880
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Provider Business Mailing Address
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Address Line | 242 WEST VALLEY AVENUE SUITE 101
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3635
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Country | US
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Telephone | 205-290-7878
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Fax | 205-290-7880
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC CHRISTOPHER VANCE
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Credential | D.M.D.
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Telephone | 205-757-7509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5830-C1
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License Number State | AL
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