Provider Demographics
NPI:1861599656
Name:CILETTI, ALFRED MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:MICHAEL
Last Name:CILETTI
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:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0312
Mailing Address - Country:US
Mailing Address - Phone:631-765-1262
Mailing Address - Fax:631-765-1461
Practice Address - Street 1:44655 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-5019
Practice Address - Country:US
Practice Address - Phone:631-765-1262
Practice Address - Fax:631-765-1461
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0351171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice