Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | M5840 | TX |
NPI | 1417111691 |
---|---|
Provider Name | Dr. Dennis Earl Minotti II |
First Address | Southlake, TX 76092-6001 |
Second Address | Southlake, TX 76092-7846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 27/05/2020 |