Healthcare Provider Details

I. General information

NPI: 1861599656
Provider Name (Legal Business Name): ALFRED MICHAEL CILETTI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44655 COUNTY ROAD 48
SOUTHOLD NY
11971-5019
US

IV. Provider business mailing address

PO BOX 312
SOUTHOLD NY
11971-0312
US

V. Phone/Fax

Practice location:
  • Phone: 631-765-1262
  • Fax: 631-765-1461
Mailing address:
  • Phone: 631-765-1262
  • Fax: 631-765-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number035117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: