Provider Demographics
NPI:1346373347
Name:VANCE, JODY BRIAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:BRIAN
Last Name:VANCE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 E MONTCLAIR ST STE G
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4786
Mailing Address - Country:US
Mailing Address - Phone:417-889-5297
Mailing Address - Fax:417-889-6462
Practice Address - Street 1:3331 E MONTCLAIR ST STE G
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4786
Practice Address - Country:US
Practice Address - Phone:417-889-5297
Practice Address - Fax:417-889-6462
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0156231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics