Provider Demographics
NPI:1205082096
Name:CIERI, ROBERT L (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:CIERI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-2911
Mailing Address - Country:US
Mailing Address - Phone:203-938-0211
Mailing Address - Fax:203-834-0215
Practice Address - Street 1:73 REDDING ROAD
Practice Address - Street 2:UNIT 5
Practice Address - City:GEORGETOWN
Practice Address - State:CT
Practice Address - Zip Code:06829
Practice Address - Country:US
Practice Address - Phone:203-544-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002057760Medicaid