IndividualActive
Anthony Mongillo, D.M.D, M.S.
NPI 1669886982 · Orthodontics and Dentofacial Orthopedics Dentistry · Idaho Falls, ID
Provider details
- NPI number
- 1669886982
- Entity type
- Individual
- Primary specialty
- Orthodontics and Dentofacial Orthopedics DentistryDental Providers
- Credential
- D.M.D, M.S.
- Sex
- Male
- Sole proprietor
- No
- License
- 1569 (WY)
Specialties & taxonomies
Dental Providers
Dental Providers
Dental Providers
Practice location
250 S Skyline Dr Ste 4
Idaho Falls, ID 83402-3292
Phone: (208) 524-1404
Approximate (ZIP-level) locationGet directions
Mailing address
250 S Skyline Dr Ste 4
Idaho Falls, ID 83402-3292
Registry dates
- Enumerated
- 2014-06-13
- 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.