Basic Information
| Provider Information | |||||||||
| NPI: | 1255318580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANCE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 398 192ND ARMORED TANK BN RD, BLDG 1022 RM 231 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401215116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026246158 | ||||||||
| FaxNumber: | 5026242966 | ||||||||
| Practice Location | |||||||||
| Address1: | 398 192ND ARMORED TANK BN RD, BLDG 1022 RM 231 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401215116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026268301 | ||||||||
| FaxNumber: | 5026242966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 7698 | KY | Y | Dental Providers | Dentist | General Practice |
No ID Information.