Provider Demographics
NPI:1225156169
Name:KIERNAN, BRIAN D (DMD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:KIERNAN
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 1:205 EMERSON CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6900
Mailing Address - Country:US
Mailing Address - Phone:908-688-0022
Mailing Address - Fax:
Practice Address - Street 1:1441 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3321
Practice Address - Country:US
Practice Address - Phone:908-688-0022
Practice Address - Fax:908-851-9079
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016053001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics