MEDICARE: DR. SNEHA INNES D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D11608	OR
2	122300000X	Dentist	11417672-9921	UT
3	122300000X	Dentist	54789	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11417672-9921	OTHER	UT	DDS LICENSE
2	D11608	OTHER	OR	DDS LICENSE
3	54789	OTHER	CA	DDS LICENSE

General Provider Information

NPI Number	:	1073650552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SNEHA INNES D.D.S.

Provider Business Mailing Address
First Line	:	4021 OCEANVIEW DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95742-6737
Country	:	US
Telephone Number	:	707-864-9904
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 SPRINGS RD
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-5713
Country	:	US
Telephone Number	:	707-642-3711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	06/11/2026

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