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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