Provider Demographics
NPI:1336143874
Name:JOSEPH, ALFRED CORNELIUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:CORNELIUS
Last Name:JOSEPH
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 1:311 WESTERVELT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1470
Mailing Address - Country:US
Mailing Address - Phone:718-981-2289
Mailing Address - Fax:718-981-8525
Practice Address - Street 1:311 WESTERVELT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1470
Practice Address - Country:US
Practice Address - Phone:718-981-2289
Practice Address - Fax:718-981-8525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0310921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice