Provider Demographics
NPI:1649321803
Name:TIERNEY, MARY ELIZABETH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4700 N WESTERN AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2081
Mailing Address - Country:US
Mailing Address - Phone:773-293-2700
Mailing Address - Fax:
Practice Address - Street 1:4700 N WESTERN AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2081
Practice Address - Country:US
Practice Address - Phone:773-293-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry