Anthony Mongillo, D.M.D, M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D-4708-OR Issued in ID

Practice address

250 S Skyline Dr Ste 4
Idaho Falls, ID 83402-3292

Phone

(208) 524-1404

NPI assigned

Jun 13, 2014

Last updated

May 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alligator Orthodontics, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Ammon, ID
  • NPI 1992553499
  NPD Authorized official
• Mongillo Orthodontics, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Idaho Falls, ID
  • NPI 1043904659
  NPD Authorized official
• Boise Orthodontics P.a.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Boise, ID
  • NPI 1770754186
  NPD (past)

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

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1669886982",
    "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": "834023292",
            "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": "834023292",
            "telephone_number": "208-524-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONGILLO",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.M.D, M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-13",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2014017950",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WY",
            "license": "1569",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "D-4708-OR",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• 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.