Katherine Talitha Anne Vance, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

108262 Issued in CA

Practice address

328 Commercial Rd Ste 104
San Bernardino, CA 92408-3766

Phone

(909) 799-9988

NPI assigned

Sep 15, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robert J Wagner DDS, Inc.

  • Dental Clinic/Center
  • San Bernardino, CA
  • NPI 1982285771
  NPD
• Sayler Dental PLLC

  • General Practice Dentistry
  • Thief River Falls, MN
  • NPI 1295505196
  NPD

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1457966566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4886 GARDENIA ST",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920575431",
            "telephone_number": "218-689-6363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "328 COMMERCIAL RD STE 104",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083766",
            "telephone_number": "909-799-9988"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 1st St E",
            "address_purpose": "LOCATION",
            "city": "Thief River Falls",
            "state": "MN",
            "postal_code": "567012404",
            "country_code": "US",
            "telephone_number": "218-681-1700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANCE",
        "first_name": "KATHERINE",
        "middle_name": "TALITHA ANNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-15",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14482",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "108262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellie Van Heerde
• Amanda Rose Van Mecl, DO
• Rebecca Van Sickle, PH.D.
• Celissa Arlitha Van
• Famida Vanat
• Michael William Vanden Berge
• Jaclyn Marie Vander Veen
• Denier Vandergon
• Willem Vanderpauwert, LCSW
• Desiree Vandyck, BA

• Dentist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; 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.