Provider Demographics
NPI:1942309877
Name:TIERNAN, PAUL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:TIERNAN
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 1:30 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6615
Mailing Address - Country:US
Mailing Address - Phone:707-546-4727
Mailing Address - Fax:707-546-3123
Practice Address - Street 1:30 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6615
Practice Address - Country:US
Practice Address - Phone:707-546-4727
Practice Address - Fax:707-546-3123
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADA0357871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU29295Medicare UPIN