Shane Robert McTiernan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN25009 Issued in FL

Practice address

651 Nautica Dr Unit 1
Jacksonville, FL 32218-7222

Phone

(904) 423-4014

NPI assigned

Jun 29, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jacksonville Florida North, PLLC

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1982414066
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1376160010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10020 INVENTION LN",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322564093",
            "telephone_number": "570-687-0798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 NAUTICA DR UNIT 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187222",
            "telephone_number": "904-423-4014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCTIERNAN",
        "first_name": "SHANE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-29",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "7968",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN25009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly McShane, PMHNP
• Taylor McShee, FNP
• Courtney J McSwain, RBT
• Morgan McSwain
• Chris McTarnaghan, MSW, LCSW
• Kimberly McVeigh, OT
• Curtis McWaine II, M.S.
• Arianna McWilliams
• Brian Jason McWilliams, AA-C
• Cameran Elise McWilliams

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.