Healthcare Provider Details

I. General information

NPI: 1104991363
Provider Name (Legal Business Name): JAMES FERRIS MOSE YANNEY DDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 WILLAMETTE FALLS DR SUITE D
WEST LINN OR
97068-4661
US

IV. Provider business mailing address

1672 WILLAMETTE FALLS DR SUITE D
WEST LINN OR
97068-4661
US

V. Phone/Fax

Practice location:
  • Phone: 503-722-4377
  • Fax: 503-722-4413
Mailing address:
  • Phone: 503-722-4377
  • Fax: 503-722-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6119
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number17195
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD15327
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: