Provider Demographics
NPI:1518932359
Name:CARLETTI, JOHN ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:CARLETTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:ANDREW
Other - Last Name:CARLETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:623 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-5101
Mailing Address - Country:US
Mailing Address - Phone:918-224-0369
Mailing Address - Fax:918-224-9518
Practice Address - Street 1:623 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5101
Practice Address - Country:US
Practice Address - Phone:918-224-0369
Practice Address - Fax:918-224-9518
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK730968397OtherT.I.N.