Jody Brian Vance, D.D.S, M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

015623 Issued in MO

Practice address

3331 E Montclair St Ste G
Springfield, MO 65804-4786

Phone

(417) 889-5297

Fax

(417) 889-6462

NPI assigned

Mar 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346373347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3331 E MONTCLAIR ST STE G",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044786",
            "telephone_number": "417-889-5297",
            "fax_number": "417-889-6462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 E MONTCLAIR ST STE G",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044786",
            "telephone_number": "417-889-5297",
            "fax_number": "417-889-6462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANCE",
        "first_name": "JODY",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S, M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MO",
            "license": "015623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luke A Van Kirk, DO
• Alisyn L Van Note, MS, LPC
• Elisabeth Van Valkenburg
• Nicholas Van Valkenburg
• Amanda Grace Vance, FNP
• Andrew Christian Vandas, PA-C
• Marcy Dee Vandeberg, MSW, LCSW
• Sydney Katherine Vandegrift, LCSW
• Grace Vander Ley
• Mark L Vandersnick, MSPT

• Periodontics in Springfield, MO
• Providers in Springfield, MO by specialty
• Periodontics in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.