Provider Demographics
NPI:1700185824
Name:VANCE, MARC CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:CHRISTOPHER
Last Name:VANCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 W VALLEY AVE STE 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 W VALLEY AVE STE 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
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5830C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice