Mongillo Orthodontics, PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

MONGILLO ORTHODONTICS, PLLC

Practice address

250 S Skyline Dr Ste 4
Idaho Falls, ID 83402-3294

Phone

(208) 524-1404

NPI assigned

Jun 6, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anthony David Mongillo, DMD, MSNPI 1669886982

Title

Sole Member/Orthodontist

Phone

(208) 524-1404

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anthony Mongillo, D.M.D, M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Idaho Falls, ID
  • NPI 1669886982
  NPD Authorized official
• Phillip David Lowder, D.D.S., M.CL.D

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Idaho Falls, ID
  • NPI 1902949969
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1043904659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 S SKYLINE DR STE 4",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023294",
            "telephone_number": "208-524-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S SKYLINE DR STE 4",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023294",
            "telephone_number": "208-524-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONGILLO ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-06",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "MONGILLO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "SOLE MEMBER/ORTHODONTIST",
        "authorized_official_telephone_number": "208-524-1404",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Molino, BCBA
• Pete Scott Molino, M.ED, BCBA
• Momentum Home Health Idaho LLC
• Momentum Hospice Idaho LLC
• Monarch Healthcare PLLC
• Anthony Mongillo, D.M.D, M.S.
• Christian D Monson, M.D.
• Itzel Montero
• Monticello Montessori Charter School, Inc
• Steveb John Moody, LPC

• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.