Organization
MONGILLO ORTHODONTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY DAVID MONGILLO DMD, MS (SOLE MEMBER/ORTHODONTIST)
(208) 524-1404
Entity
Organization
Contact information
Practice address
250 S SKYLINE DR STE 4, IDAHO FALLS, ID 83402-3294
(208) 524-1404
Mailing address
250 S SKYLINE DR STE 4, IDAHO FALLS, ID 83402-3294
(208) 524-1404
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
06/06/2023
Last updated
05/09/2024
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