Provider Demographics
NPI:1205927696
Name:VANCE, GREGORY SHAWN (DMD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SHAWN
Last Name:VANCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3285 BLAZER PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2119
Mailing Address - Country:US
Mailing Address - Phone:859-264-1854
Mailing Address - Fax:859-264-1855
Practice Address - Street 1:3285 BLAZER PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2119
Practice Address - Country:US
Practice Address - Phone:859-264-1854
Practice Address - Fax:859-264-1855
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY76301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics