Provider Demographics
NPI:1053669648
Name:ADVANCE DENTAL, P.C.
Entity Type:Organization
Organization Name:ADVANCE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-757-7509
Mailing Address - Street 1:242 WEST VALLEY AVENUE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3635
Mailing Address - Country:US
Mailing Address - Phone:205-290-7878
Mailing Address - Fax:205-290-7880
Practice Address - Street 1:242 WEST VALLEY AVENUE SUITE 101
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3635
Practice Address - Country:US
Practice Address - Phone:205-290-7878
Practice Address - Fax:205-290-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5830-C1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental