Individual
EUGENE JOHN MINALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
3400 N. LINDER AVE, CHICAGO, IL 60641
(773) 545-0041
Mailing address
3400 N. LINDER AVE, CHICAGO, IL 60641
(773) 545-0041
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4663T
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506582
—
NV
Enumeration date
10/24/2006
Last updated
08/15/2011
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