Provider Demographics
NPI:1013183268
Name:VANCE, ALAN KELSO (DDS)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:KELSO
Last Name:VANCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 QUARRIER ST SUITE 502
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-343-1733
Mailing Address - Fax:304-343-1734
Practice Address - Street 1:1031 QUARRIER ST SUITE 502
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-343-1733
Practice Address - Fax:304-343-1734
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWC25531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice