Mongillo Orthodontics, Pllc
NPI #1043904659 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1043904659
- Entity Type
- Organization
- Organization Name
- Mongillo Orthodontics, Pllc
- Primary Specialty
- Dentist - Orthodontics and Dentofacial Orthopedics
- Enumeration Date
- Jun 6, 2023
- Last Updated
- May 9, 2024
Practice Location
- Address
- 250 S SKYLINE DR STE 4
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83402-3294
- Phone
- (208) 524-1404
Authorized Official
- Name
- DR. ANTHONY DAVID MONGILLO, DMD, MS
- Title
- SOLE MEMBER/ORTHODONTIST
- Phone
- (208) 524-1404
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics |
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