Provider Demographics
NPI:1699796771
Name:VANCIL, BRIAN D (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:VANCIL
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 1:1905 MALL OF GEORGIA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519
Mailing Address - Country:US
Mailing Address - Phone:678-714-6343
Mailing Address - Fax:678-714-6345
Practice Address - Street 1:1905 MALL OF GEORGIA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:678-714-6343
Practice Address - Fax:678-714-6345
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158831223G0001X
GA0124411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice