Provider Demographics
NPI:1104991363
Name:YANNEY, JAMES FERRIS MOSE (DDS MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FERRIS MOSE
Last Name:YANNEY
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1672 WILLAMETTE FALLS DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4661
Mailing Address - Country:US
Mailing Address - Phone:503-722-4377
Mailing Address - Fax:503-722-4413
Practice Address - Street 1:1672 WILLAMETTE FALLS DR
Practice Address - Street 2:SUITE D
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4661
Practice Address - Country:US
Practice Address - Phone:503-722-4377
Practice Address - Fax:503-722-4413
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61191223S0112X
SC17195204E00000X
ORMD15327204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
194626700OtherUS DEPT OF LABOR
194626700OtherUS DEPT OF LABOR
0000BTBNHMedicare ID - Type Unspecified