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Alligator Orthodontics, LLC

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Company Details

Name: Alligator Orthodontics, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 29 Aug 2023 (2 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 5374940
Place of Formation: IDAHO
File Number: 895987
ZIP code: 83406
County: Bonneville County
Principal Address: 3067 EAGLE DRIVE AMMON, ID 83406
Mailing Address: ATTN: CAMERON SMITH 2805 EAGLE DR AMMON, ID 83406-5769

Agent

Name Role Address
Randy G. Smith Agent 362 PALIMINO DRIVE, IDAHO FALLS, ID 83404

Member

Name Role Address Appointed On
Mark W. Marlowe Member 2326 PTARMIGAN WAY, AMMON, ID 83406 2024-07-03
Anthony D. Mongillo Member 4870 PAVERO DRIVE, IDAHO FALLS, ID 83404 2024-07-03

Manager

Name Role Address Appointed On
Randy G. Smith Manager 362 PALIMINO DRIVE, IDAHO FALLS, ID 83404 2024-07-03

National Provider Identifier

NPI Number:
1992553499
Certification Date:
2024-05-09

Authorized Person:

Name:
DR. ANTHONY MONGILLO
Role:
MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
1223P0221X - Pediatric Dentist
Is Primary:
No
Selected Taxonomy:
1223X0400X - Orthodontics and Dentofacial Orthopedic Dentist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005797871 2024-07-03
Statement of Change of Business Mailing Address 0005698779 2024-04-21
Initial Filing 0005374940 2023-08-29

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Date of last update: 21 May 2025

Sources: Idaho Secretary of State