Provider Demographics
NPI:1699377952
Name:INNES, JAMES ANDREW-ACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW-ACOB
Last Name:INNES
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 1:4804 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2850
Mailing Address - Country:US
Mailing Address - Phone:509-453-4504
Mailing Address - Fax:
Practice Address - Street 1:4804 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2850
Practice Address - Country:US
Practice Address - Phone:509-452-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36860122300000X
WADE61215060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist