Provider Demographics
NPI:1871854018
Name:TIERNEY, CHRISTINE L (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E PUTNAM AVE
Mailing Address - Street 2:VALLEYWOOD MEDICAL BUILDING
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2600
Mailing Address - Country:US
Mailing Address - Phone:203-869-5400
Mailing Address - Fax:203-869-0574
Practice Address - Street 1:40 E PUTNAM AVE
Practice Address - Street 2:VALLEYWOOD MEDICAL BUILDING
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2600
Practice Address - Country:US
Practice Address - Phone:203-869-5400
Practice Address - Fax:203-869-0574
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist