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

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

019.022613 Issued in IL

Practice address

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

Phone

(815) 356-7960

Fax

(815) 356-8051

NPI assigned

Jul 14, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crystal Lake Pediatric Dental LTD.

  • Pediatric Dentistry
  • Crystal Lake, IL
  • NPI 1043311681
  NPD (past)

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215993600000",
    "number": "1427212018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE",
            "address_2": "SUITE 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": "SUITE 111",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143649",
            "telephone_number": "815-356-7960",
            "fax_number": "815-356-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINUTILLO",
        "first_name": "TONY",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2008-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.022613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Jul 14, 2008; 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.