| NPI | 1043904659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY DAVID MONGILLO Sole Member/Orthodontist 208-524-1404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2024-05-09 |