CRYSTAL LAKE PEDIATRIC DENTAL LTD. (NPI# 1043311681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043311681 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE PEDIATRIC DENTAL LTD. |
| Practice Address |
820 E Terra Cotta Ave 111 Crystal Lake IL 60014-3649 |
| Practice Telephone | 8153567960 |
| Practice Fax Number | 8153568051 |
| Mailing Telephone | 8153567960 |
| Mailing Fax Number | 8153568051 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. ANTHONY LOUIS MINUTILLO (PRESIDENT) |
| Authorized Official Telephone | 8153567960 |
| Authorized Official Credential | DDS,MSD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
IL | Dental Providers |
| Street Address |
820 E TERRA COTTA AVE 111 |
| City | CRYSTAL LAKE |
| State | IL |
| Zip Code | 60014-3649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134100688 | Barry A Altshuler | Pediatrics | 820 E Terra Cotta Ave, Suite 226, Crystal Lake, IL 60014-3649 | 2005-11-10 |
| 1710437694 | Jane Dintzner | Massage Therapist | 820 E Terra Cotta Ave, Suite 101, Crystal Lake, IL 60014-3649 | 2016-10-04 |
| 1407267842 | Home Care Personal Services, Inc. | Home Health | 820 E Terra Cotta Ave, Suite 112, Crystal Lake, IL 60014-3649 | 2014-05-19 |
| 1326310921 | Nature's Balance Acupuncture | Massage Therapist | 820 E Terra Cotta Ave, Suite 101, Crystal Lake, IL 60014-3649 | 2012-01-30 |
| 1164728374 | James P Grimm | Counselor | 820 E Terra Cotta Ave, Suite 215, Crystal Lake, IL 60014-3649 | 2011-02-04 |
| 1851605240 | Behavioral Vision, Ltd. | Optometrist | 820 E Terra Cotta Ave, Suite 256, Crystal Lake, IL 60014-3649 | 2010-07-28 |
| 1508188244 | Lafazanos Dental PC | Dentist | 820 E Terra Cotta Ave, Suite 218/220, Crystal Lake, IL 60014-3649 | 2010-02-22 |
| 1427212018 | Tony Louis Minutillo | Dentist | 820 E Terra Cotta Ave, Suite 111, Crystal Lake, IL 60014-3649 | 2008-07-14 |
| 1952560443 | Jacob Allen Klaustermeier | Dermatology | 820 E Terra Cotta Ave, Crystal Lake, IL 60014-3649 | 2008-06-09 |
| 1376711101 | Janet A Rutherford | Physical Therapist | 820 E Terra Cotta Ave, Suite 102, Crystal Lake, IL 60014-3649 | 2008-02-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497394720 | Lorelei Mariano | Physical Therapist | 350 E Congress Parkway Ste A, Crystal Lake, IL 60014 | 2020-01-03 |
| 1396227070 | Behavioral Services for Autism, Inc | Behavioral Analyst | 1095 Pingree Road, Suite 204, Crystal Lake, IL 60014 | 2018-08-30 |
| 1831635564 | Isis Mendoza-garnica | Counselor | 6803 Rose Ave, Crystal Lake, IL 60014 | 2017-01-19 |
| 1134664402 | Derick Dermatology, LLC | Non-Pharmacy Dispensing Site | 525 E Congress Parkway, Suite 200, Crystal Lake, IL 60014 | 2016-12-22 |
| 1306394051 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 177 W Virginia Street, Crystal Lake, IL 60014 | 2016-09-12 |
| 1124492830 | Align Spine & Orthopaedics | Durable Medical Equipment & Medical Supplies | 60 B West Terra Cotta Ave, #265, Crystal Lake, IL 60014 | 2015-11-18 |
| 1558747428 | Shabana Nawaz | Optometrist | 4777 Northwest Highway, Crystal Lake, IL 60014 | 2015-08-03 |
| 1548649205 | Daniel Okon | Social Worker | 304 Charllote Ave, Crystal Lake, IL 60014 | 2015-05-27 |
| 1154729838 | Crystal Lake Center for Chronic Pain Sc | Nurse Practitioner | 1 South Northwest Highway, Crystal Lake, IL 60014 | 2014-12-12 |
| 1558763581 | Brooke Nicole Grandt | Occupational Therapist | 394 Heisler Ct, Crystal Lake, IL 60014 | 2014-09-22 |
| Find all providers in zip 60014 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073956017 | Kathleen A. Schroeder Dds | Dentist | 278 Memorial Dr, Crystal Lake, IL 60014-6246 | 2013-04-09 |
| 1568709988 | Pediatric Dental Associates, PC | Dentist | 690 N Il Route 31, Suite D, Crystal Lake, IL 60012-3790 | 2013-01-04 |
| 1053657809 | First Smiles Dental, PC | Dentist | 278 Memorial Dr, Suite B, Crystal Lake, IL 60014-6246 | 2012-12-26 |
| 1427212018 | Tony Louis Minutillo | Dentist | 820 E Terra Cotta Ave, Suite 111, Crystal Lake, IL 60014-3649 | 2008-07-14 |
| 1245450113 | Scott D Goldman | Dentist | 278 Memorial Dr, Crystal Lake, IL 60014-6246 | 2007-04-26 |
| 1063526796 | Fred M Fitzpatrick | Dentist | 690 N Il Route 31, Crystal Lake, IL 60012-3790 | 2006-08-19 |
| 1700990447 | Frederick M. Fitzpatrick, D.d.s., P.C. | Dentist | 690 N Il Route 31, Crystal Lake, IL 60012-3790 | 2006-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932709433 | Children's Center for Dentistry | Dentist | 314 Susan Dr, Normal, IL 61761-6206 | 2020-10-26 |
| 1073125746 | Jessica Mattern Dds, Pllc | Dentist | 326 W Burlington Ave, La Grange, IL 60525-2363 | 2020-08-23 |
| 1568925014 | Southern Illinois Pediatric Dentistry of Edwardsville | Dentist | 1419 Lewis Road, Suite 2, Edwardsville, IL 62025 | 2019-04-11 |
| 1710450754 | Drs Selberg & Rice Pllc | Dentist | 4945 Stone Falls Ctr Ste B, O Fallon, IL 62269-7801 | 2019-01-02 |
| 1821583634 | Dentalgenix | Dentist | 113 E Schaumburg Rd, Schaumburg, IL 60194-3518 | 2018-06-25 |
| 1528562253 | Rachel Vorwaller | Dentist | 1460 N Halsted St Ste 403, Chicago, IL 60642-2607 | 2018-03-19 |
| 1942740006 | Dhwani M. Joshi | Dentist | 195 S Rand Rd Ste 110, Lake Zurich, IL 60047-2205 | 2017-03-08 |
| 1316393390 | Erin Marie Petrik | Dentist | 2530 N Clark St, Apt 203, Chicago, IL 60614-4972 | 2016-05-10 |
| 1669839593 | Algonquin Kids Dentistry, Inc | Dentist | 4097 W Algonquin Rd, Algonquin, IL 60102-9401 | 2016-01-22 |
| 1720468598 | Mehedia Haque | Dentist | 2062 N Milwaukee Ave, Chicago, IL 60647 | 2015-06-05 |
| Find all providers with the same taxonomy | ||||
| City | CRYSTAL LAKE |
| Zip Code | 60014 |
Please comment or provide details below to improve the information on CRYSTAL LAKE PEDIATRIC DENTAL LTD..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.