Provider Demographics
NPI:1578662011
Name:MACINNES, MICHAEL ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLAN
Last Name:MACINNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 228TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074
Mailing Address - Country:US
Mailing Address - Phone:425-391-8830
Mailing Address - Fax:425-391-8857
Practice Address - Street 1:336 228TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074
Practice Address - Country:US
Practice Address - Phone:425-391-8830
Practice Address - Fax:425-391-8857
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist