Active NPI
Mellissa Ann Ilgen, D.D.S.
- General Practice Dentistry
- Bellevue, WA
National Provider Identifier
1790037547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE60679147
- Practice address
- 4100 Factoria Blvd. SE
Suite C
Bellevue, WA 98006 - Phone
- (425) 747-7000
- Fax
- (303) 648-5610
- NPI assigned
- Oct 3, 2012
- Last updated
- Apr 19, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE60679147 | WA | Primary |
Addresses
Primary practice location
4100 Factoria Blvd. SE
Suite C
Bellevue, WA 98006
Mailing address
4100 Factoria Blvd. SE
Suite C
Bellevue, WA 98006
Phone (425) 747-7000
Other names 1
- Dr. Mellissa Ann Gilman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60679147 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cooleys DDS PS | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555632000000",
"number": "1790037547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 FACTORIA BLVD. SE",
"address_2": "SUITE C",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "98006",
"telephone_number": "425-747-7000",
"fax_number": "303-648-5610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 FACTORIA BLVD. SE",
"address_2": "SUITE C",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "98006",
"telephone_number": "425-747-7000",
"fax_number": "303-648-5610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILGEN",
"first_name": "MELLISSA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-03",
"last_updated": "2019-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE60679147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MELLISSA",
"last_name": "GILMAN",
"middle_name": "ANN",
"prefix": "DR.",
"credential": "D.D.S.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.