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General NPI Number Information
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NPI Number | 1043620131
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Entity Type | Organization
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Legal Business Name | MICHAEL T TIERNEY DDS.LTD
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 4781 STATE ROUTE 71
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City | OSWEGO
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State | IL
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Zip | 60543-7415
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Country | US
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Telephone | 630-554-5157
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Fax | 630-554-5487
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Provider Business Mailing Address
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Address Line | 4781 STATE ROUTE 71
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City | OSWEGO
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State | IL
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Zip | 60543-7415
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Country | US
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Telephone | 630-554-5157
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Fax | 630-554-5487
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL T TIERNEY
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Credential | DDS
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Telephone | 630-554-5157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01914998
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License Number State | IL
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