NPI 1043311681

Crystal Lake Pediatric Dental LTD.

Organisation Pediatric Dentistry Crystal Lake, IL

Practice location

Address: 820 E Terra Cotta Ave 111, Crystal Lake, IL 60014-3649
Phone: (815) 356-7960
Fax: (815) 356-8051

Authorised official

Name: Anthony Louis Minutillo
Title: President
Phone: (815) 356-7960

Registered specialties

Pediatric Dentistry Primary

Dental Providers Taxonomy 1223P0221X

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Registry record

NPI: 1043311681
Entity type: Organization
NPI issued: 26 Sep 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.