Provider Demographics
NPI:1457564296
Name:MINUTELLO, JAMES S
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:MINUTELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:MINUTELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:16574 BRIGHTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-9702
Mailing Address - Country:US
Mailing Address - Phone:951-359-1472
Mailing Address - Fax:951-279-7422
Practice Address - Street 1:770 MAGNOLIA AVE SUITE 2-E
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3122
Practice Address - Country:US
Practice Address - Phone:951-279-7847
Practice Address - Fax:951-279-7422
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0352981223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics