Provider Demographics
NPI:1619960820
Name:INNES, JOSEPH CRIST (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CRIST
Last Name:INNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18161 SANTA JOANANA
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5643
Mailing Address - Country:US
Mailing Address - Phone:714-962-4004
Mailing Address - Fax:760-725-7461
Practice Address - Street 1:1STDENBN/NDC CAMP PENDLETON
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5221
Practice Address - Country:US
Practice Address - Phone:760-725-7704
Practice Address - Fax:760-725-7461
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423311223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics