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General NPI Number Information
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NPI Number | 1457966566
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Entity Type | Individual
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Provider Name | KATHERINE TALITHA ANNE VANCE DDS
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 328 COMMERCIAL RD STE 104
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3766
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Country | US
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Telephone | 909-799-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 4886 GARDENIA ST
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City | OCEANSIDE
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State | CA
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Zip | 92057-5431
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Country | US
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Telephone | 218-689-6363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D14482
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 108262
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License Number State | CA
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