Organization
ALLIGATOR ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY MONGILLO DMD (MANAGER)
(208) 542-1333
Entity
Organization
Contact information
Practice address
2805 EAGLE DR, AMMON, ID 83406-5769
(208) 542-1333
Mailing address
2805 EAGLE DR, AMMON, ID 83406-5769
(208) 542-1333
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/09/2024
Last updated
05/09/2024
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