MEDICARE: DR. DANIEL M. MELE III, DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1326429861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. DANIEL M. MELE III, DMD

Provider Business Mailing Address
First Line	:	40 W EVERGREEN AVE
Second Line	:	SUITE 111
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3324
Country	:	US
Telephone Number	:	215-242-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 W EVERGREEN AVE
Second Line	:	SUITE 111
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3324
Country	:	US
Telephone Number	:	215-242-9411
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	JANET MELE
Credential	:
Telephone Number	:	215-242-9411

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	06/10/2015

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