Provider Demographics
NPI:1356238729
Name:YINEMAN, JAKE (DMD)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:YINEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 E VIA DE LOS LIBROS
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3500
Mailing Address - Country:US
Mailing Address - Phone:701-214-9358
Mailing Address - Fax:
Practice Address - Street 1:7552 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3511
Practice Address - Country:US
Practice Address - Phone:480-429-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0125721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice