Provider Demographics
NPI:1881271997
Name:VANCE, DYLAN GARRETT (MD)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:GARRETT
Last Name:VANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3444
Mailing Address - Country:US
Mailing Address - Phone:973-970-4339
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST STE MSB 5036
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-486-5000
Practice Address - Fax:713-383-1410
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program