Individual
DR. ANTHONY MONGILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D, M.S.
Contact information
Practice address
250 S SKYLINE DR STE 4, IDAHO FALLS, ID 83402-3292
(208) 524-1404
Mailing address
250 S SKYLINE DR STE 4, IDAHO FALLS, ID 83402-3292
(208) 524-1404
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2014017950
MO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
1569
WY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-4708-OR
ID
Other
Enumeration date
06/13/2014
Last updated
05/09/2024
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