Provider Demographics
NPI:1841306396
Name:VANCE, MITCHELL ARNOLD (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ARNOLD
Last Name:VANCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10787 FOLKESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1313
Mailing Address - Country:US
Mailing Address - Phone:410-480-1862
Mailing Address - Fax:
Practice Address - Street 1:9011 CHEVROLET DR
Practice Address - Street 2:SUITE 9
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4024
Practice Address - Country:US
Practice Address - Phone:410-750-7051
Practice Address - Fax:410-750-7394
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005464056Medicare UPIN
8702Medicare UPIN