Healthcare Provider Details

I. General information

NPI: 1306096797
Provider Name (Legal Business Name): JAMES FM YANNEY DDS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 05/06/2015
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 TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD15327
License Number StateOR

VIII. Authorized Official

Name: DR. JAMES F.M. YANNEY
Title or Position: PHYSICIAN
Credential: MD
Phone: 503-722-4377