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General NPI Number Information
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NPI Number | 1417111691
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Entity Type | Individual
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Provider Name | DENNIS EARL MINOTTI II D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 230 MIRON DR STE 110
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7846
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Country | US
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Telephone | 817-416-0970
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Fax | 817-898-0898
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Provider Business Mailing Address
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Address Line | 804 BRAZOS DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6001
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Country | US
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Telephone | 817-507-6917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | M5840
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License Number State | TX
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