Provider Demographics
NPI:1790859742
Name:TIERNEY, EDWARD RANDAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RANDAL
Last Name:TIERNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:E RANDY
Other - Middle Name:
Other - Last Name:TIERNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:556 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5074
Mailing Address - Country:US
Mailing Address - Phone:360-683-7168
Mailing Address - Fax:
Practice Address - Street 1:556 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-5074
Practice Address - Country:US
Practice Address - Phone:360-683-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA66361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice