ANTHONY MONGILLO (NPI# 1669886982) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669886982 |
| Entity Type | Individual |
| Full Name | ANTHONY MONGILLO |
| Credential | D.M.D, M.S. |
| Practice Address |
4725 N Cloverdale Rd Suite 101 Boise ID 83713-4911 |
| Mailing Address |
6333 N Heathrow Ct Boise ID 83713-0970 |
| Practice Telephone | 2083234458 |
| Mailing Telephone | 9547893410 |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2016-10-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 2014017950 | MO | Dental Providers |
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
D-4708-OR | ID | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558324228 | Anthony Mongillo | Internal Medicine | 3180 Main St, Suite 301, Bridgeport, CT 06606-4237 | 2006-04-11 |
| Street Address |
4725 N CLOVERDALE RD SUITE 101 |
| City | BOISE |
| State | ID |
| Zip Code | 83713-4911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154338812 | Glen Allen Smith | Dentist | 4725 N Cloverdale Rd, Boise, ID 83713 | 2006-08-02 |
| 1770754186 | Boise Orthodontics P.a. | Dentist | 4725 N Cloverdale Rd, Suite 101, Boise, ID 83713-4911 | 2008-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801061080 | Laura Kathleen Lineberry | Dentist | 13059 W Persimmon Ln, Boise, ID 83713-1986 | 2008-04-28 |
| 1194910778 | Scott D Alexander | Dentist | 3167 South Bown Way, Boise, ID 83706 | 2007-09-07 |
| 1952504318 | Jacob Reed Jarivs | Dentist | 6000 S Quamash Way, Boise, ID 83716-5617 | 2007-06-05 |
| 1588879399 | Jon Miler | Dentist | 5220 N Eagle Rd, Boise, ID 83713-0945 | 2007-05-14 |
| 1194814251 | Steven David Gilman | Dentist | 7301 W Emerald St Ste 101, Boise, ID 83704-8689 | 2006-10-12 |
| 1396843058 | Marcus Lowry | Dentist | 9460 W. Franklin Rd, Boise, ID 83709 | 2006-09-20 |
| 1346344884 | John C. Slattery | Dentist | 600 E Riverpark Ln, Suite 100, Boise, ID 83706-6551 | 2006-09-12 |
| 1265535298 | James Kelly Poulsen | Dentist | 1453 W Hays, Boise, ID 83702 | 2006-09-06 |
| 1043322548 | Terrell F Tingey | Dentist | 2020 N Cole Rd, Boise, ID 83704 | 2006-08-31 |
| 1205943669 | John C Matunas | Dentist | 8000 Ustick Rd, Boise, ID 83704-5751 | 2006-08-23 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.