Provider Demographics
NPI:1255318580
Name:VANCE, MARK ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:VANCE
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:398 192ND ARMORED TANK BN RD, BLDG 1022 RM 231
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5116
Mailing Address - Country:US
Mailing Address - Phone:502-624-6158
Mailing Address - Fax:502-624-2966
Practice Address - Street 1:398 192ND ARMORED TANK BN RD, BLDG 1022 RM 231
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5116
Practice Address - Country:US
Practice Address - Phone:502-626-8301
Practice Address - Fax:502-624-2966
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-09-02
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Provider Licenses
StateLicense IDTaxonomies
KY76981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice