| Crystal Lake Pediatric Dental Ltd. | |
|
820 E Terra Cotta Ave 111 Crystal Lake IL 60014-3649 | |
| (815) 356-7960 | |
| (815) 356-8051 |
| Full Name | Crystal Lake Pediatric Dental Ltd. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 820 E Terra Cotta Ave, Crystal Lake, Illinois |
| Authorized Official Name and Position | Anthony Louis Minutillo (PRESIDENT) |
| Authorized Official Contact | 8153567960 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Lake Pediatric Dental Ltd. 820 E Terra Cotta Ave 111 Crystal Lake IL 60014-3649 Ph: (815) 356-7960 | Crystal Lake Pediatric Dental Ltd. 820 E Terra Cotta Ave 111 Crystal Lake IL 60014-3649 Ph: (815) 356-7960 |
| NPI Number | 1043311681 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043311681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (Illinois) | Primary |
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