Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Crystal Lake Pediatric Dental Ltd

Organization Pediatric Dentistry · NPI 1043311681

Crystal Lake Pediatric Dental Ltd is a Pediatric Dentistry in Crystal Lake, Illinois. Licensed in Illinois. Registered with an NPI since 2006.

Licensed in
IL
In the registry since
2006
What do these letters mean?
Ltd — Limited
A form of business registration, not a clinical qualification.

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Practice location Address checks out

820 E Terra Cotta Ave 111
Crystal Lake, IL 60014-3649
Phone: (815) 356-7960
Fax: (815) 356-8051
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Dentistry (primary) Taxonomy 1223P0221X (IL)

Record details

NPI number1043311681
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Anthony Minutillo — President · (815) 356-7960
NPI enumeratedSeptember 26, 2006
Last updated in NPPESAugust 22, 2020
Mailing address820 E Terra Cotta Ave, 111, Crystal Lake, IL 60014-3649

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