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Mellissa Ilgen, Dds, Pllc

NPI Registration Record

Provider / OrganizationNPIDate Certified
MELLISSA ILGEN, DDS, PLLC13862416362020-10-10
Other Names:
Entity TypeOrganization
Provider OrganizationMELLISSA ILGEN, DDS, PLLC
Other Provider OrganizationAPPLETREE COVE DENTAL CENTER
Practice Office Address26114 ILLINOIS AVE NE
KINGSTON, WA US
Practice Office Telephone3602973392
Mailing AddressPO BOX 149
KINGSTON, WA 983460149 US
Business Telephone3602973392
Authorized OfficialMELLISSA ILGEN, DENTIST
2069001417
HPT Codes
CodeLicense NoState
261QD0000X PRIMARY
OPI Codes
Governmental Registrations [CAGE/NCAGE/DUNS]

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