Provider Demographics
NPI:1902920630
Name:ILIEF ALA, MELINA AMY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELINA
Middle Name:AMY
Last Name:ILIEF ALA
Suffix:
Gender:F
Credentials:DMD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 HERRICK ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5903
Mailing Address - Country:US
Mailing Address - Phone:978-921-7575
Mailing Address - Fax:
Practice Address - Street 1:75 HERRICK ST
Practice Address - Street 2:SUITE 212
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5903
Practice Address - Country:US
Practice Address - Phone:978-921-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry