Provider Demographics
NPI:1477884468
Name:DENNIS E. MINOTTI,II,D.O.,PLLC
Entity Type:Organization
Organization Name:DENNIS E. MINOTTI,II,D.O.,PLLC
Other - Org Name:NORTH TEXAS MUSCULOSKELETAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MINOTTI
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:817-882-9848
Mailing Address - Street 1:230 MIRON DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-416-0970
Mailing Address - Fax:817-898-0898
Practice Address - Street 1:230 MIRON DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-416-0970
Practice Address - Fax:817-898-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5840305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB119922OtherPTAN