Provider Demographics
NPI:1467554923
Name:VANCE, JAMES DAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVIS
Last Name:VANCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:DAVID
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1897 PECOS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3231
Mailing Address - Country:US
Mailing Address - Phone:325-655-9133
Mailing Address - Fax:325-482-9125
Practice Address - Street 1:1897 PECOS ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3231
Practice Address - Country:US
Practice Address - Phone:325-651-3224
Practice Address - Fax:325-482-9125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX792148OtherUNITED CONCORDIA
TXD14708OtherBLUE CROSS/BLUE SHIELD
TX14708OtherDELTA DENTAL