Provider Demographics
NPI:1730849456
Name:HARTMAN, TIERNEY (RDH)
Entity type:Individual
Prefix:MRS
First Name:TIERNEY
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:TIERNEY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:166 DEFENSE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8922
Mailing Address - Country:US
Mailing Address - Phone:410-263-4300
Mailing Address - Fax:
Practice Address - Street 1:166 DEFENSE HWY STE 201
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8922
Practice Address - Country:US
Practice Address - Phone:410-263-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6798124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist