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Organization
CRYSTAL LAKE PEDIATRIC DENTAL LTD.
Active
Organization
CRYSTAL LAKE PEDIATRIC DENTAL LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY LOUIS MINUTILLO DDS,MSD (PRESIDENT)
(815) 356-7960
Entity
Organization
Contact information
Practice address
820 E TERRA COTTA AVE, 111, CRYSTAL LAKE, IL 60014-3649
(815) 356-7960
(815) 356-8051
Mailing address
820 E TERRA COTTA AVE, 111, CRYSTAL LAKE, IL 60014-3649
(815) 356-7960
(815) 356-8051
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
IL
Other
Enumeration date
09/26/2006
Last updated
08/22/2020
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