| Mongillo Orthodontics, Pllc | |
|
250 S Skyline Dr Ste 4 Idaho Falls ID 83402-3294 | |
| (208) 524-1404 | |
| Not Available |
| Full Name | Mongillo Orthodontics, Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 250 S Skyline Dr Ste 4, Idaho Falls, Idaho |
| Authorized Official Name and Position | Anthony David Mongillo (SOLE MEMBER/ORTHODONTIST) |
| Authorized Official Contact | 2085241404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mongillo Orthodontics, Pllc 250 S Skyline Dr Ste 4 Idaho Falls ID 83402-3294 Ph: (208) 524-1404 | Mongillo Orthodontics, Pllc 250 S Skyline Dr Ste 4 Idaho Falls ID 83402-3294 Ph: (208) 524-1404 |
| NPI Number | 1043904659 |
|---|---|
| Provider Enumeration Date | 06/06/2023 |
| Last Update Date | 05/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043904659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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