Provider Demographics
NPI:1457512527
Name:TIERNAN, GEORGE WASHINGTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WASHINGTON
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 1:24 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1030
Mailing Address - Country:US
Mailing Address - Phone:631-724-8365
Mailing Address - Fax:
Practice Address - Street 1:875 OLD COUNTRY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4942
Practice Address - Country:US
Practice Address - Phone:516-931-1221
Practice Address - Fax:516-861-6520
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice