MEDICARE: DR. DENNIS W KIERNAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	DN012554	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275587107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS W KIERNAN DMD

Provider Business Mailing Address
First Line	:	25501 BRAINARD AVE
Second Line	:
City	:	FT. EISENHOWER
State	:	GA
Zip	:	30905-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25501 BRAINARD AVE, USA DENTAC SNYDER DENTAL CLINIC
Second Line	:	SNYDER DENTAL CLINIC
City	:	FT. EISENHOWER
State	:	GA
Zip	:	30905-0000
Country	:	US
Telephone Number	:	706-787-7050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	03/12/2024

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