Crystal Lake Pediatric Dental LTD.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CRYSTAL LAKE PEDIATRIC DENTAL LTD.

Practice address

820 E Terra Cotta Ave
111
Crystal Lake, IL 60014-3649

Phone

(815) 356-7960

Fax

(815) 356-8051

NPI assigned

Sep 26, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anthony Louis Minutillo, DDS,MSD

Title

President

Phone

(815) 356-7960

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tony Louis Minutillo, D.D.S., M.S.D.

  • Pediatric Dentistry
  • Crystal Lake, IL
  • NPI 1427212018
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043311681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE",
            "address_2": "111",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143649",
            "telephone_number": "815-356-7960",
            "fax_number": "815-356-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE",
            "address_2": "111",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143649",
            "telephone_number": "815-356-7960",
            "fax_number": "815-356-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE PEDIATRIC DENTAL LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MINUTILLO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-356-7960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS,MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Lake Memory Care, LLC (Autumn Leaves of Crystal Lake)
• Crystal Lake Natural Health Care
• Crystal Lake Ophthalmology Associates PC
• Crystal Lake Optical Inc.
• Crystal Lake Oral Maxillofacial Surgery LTD
• Crystal Lake Pharmacy Inc
• Crystal Lake Physical Therapy Inc
• Crystal Lake Regenerative Pain Associates PLLC
• Crystal Lake Wellness, LLC
• Crystal Pines Rehabilitation and Health Care Center, LLC (Crystal Pines Rehabilitation & Health Care Center)

• Pediatric Dentistry in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.