Provider Demographics
NPI:1417111691
Name:MINOTTI, DENNIS EARL II (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EARL
Last Name:MINOTTI
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 BRAZOS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6001
Mailing Address - Country:US
Mailing Address - Phone:817-507-6917
Mailing Address - Fax:
Practice Address - Street 1:230 MIRON DR STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7846
Practice Address - Country:US
Practice Address - Phone:817-416-0970
Practice Address - Fax:817-898-0898
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5840204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM