Provider Demographics
NPI:1275587107
Name:KIERNAN, DENNIS W (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
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 1:25501 BRAINARD AVE
Mailing Address - Street 2:
Mailing Address - City:FT. EISENHOWER
Mailing Address - State:GA
Mailing Address - Zip Code:30905-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25501 BRAINARD AVE, USA DENTAC SNYDER DENTAL CLINIC
Practice Address - Street 2:SNYDER DENTAL CLINIC
Practice Address - City:FT. EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-0000
Practice Address - Country:US
Practice Address - Phone:706-787-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125541223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA153580911AMedicaid
SCZG2554Medicaid