Provider Demographics
NPI:1790037547
Name:ILGEN, MELLISSA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELLISSA
Middle Name:ANN
Last Name:ILGEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MELLISSA
Other - Middle Name:ANN
Other - Last Name:GILMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4100 FACTORIA BLVD. SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-747-7000
Mailing Address - Fax:303-648-5610
Practice Address - Street 1:4100 FACTORIA BLVD. SE
Practice Address - Street 2:SUITE C
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-747-7000
Practice Address - Fax:303-648-5610
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606791471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice