Provider Demographics
NPI:1417344557
Name:HALL, VANCE PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:PATRICK
Last Name:HALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2297 N HILL FIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6928
Mailing Address - Country:US
Mailing Address - Phone:801-758-5003
Mailing Address - Fax:801-779-4344
Practice Address - Street 1:2297 N HILL FIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6928
Practice Address - Country:US
Practice Address - Phone:801-779-0506
Practice Address - Fax:801-779-4344
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT11029187-9924204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program