OrganizationActive
Mongillo Orthodontics, PLLC
NPI 1043904659 · Orthodontics and Dentofacial Orthopedics Dentistry · Idaho Falls, ID
Provider details
- NPI number
- 1043904659
- Entity type
- Organization
- Primary specialty
- Orthodontics and Dentofacial Orthopedics DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Anthony Mongillo, Sole Member/Orthodontist(208) 524-1404
Specialties & taxonomies
Dental Providers
Practice location
250 S Skyline Dr Ste 4
Idaho Falls, ID 83402-3294
Phone: (208) 524-1404
Approximate (ZIP-level) locationGet directions
Mailing address
250 S Skyline Dr Ste 4
Idaho Falls, ID 83402-3294
Registry dates
- Enumerated
- 2023-06-06
- Last updated
- 2024-05-09
- Certified
- 2024-05-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.