Provider Demographics
NPI:1538226659
Name:CIRILLI, ALAN CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:CHARLES
Last Name:CIRILLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2121
Mailing Address - Country:US
Mailing Address - Phone:248-547-7700
Mailing Address - Fax:248-547-6054
Practice Address - Street 1:1665 12 W. MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2121
Practice Address - Country:US
Practice Address - Phone:248-547-7700
Practice Address - Fax:248-547-6054
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI113761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice