Healthcare Provider Details

I. General information

NPI: 1669005237
Provider Name (Legal Business Name): DIRECT MOBILE DENTAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MONTGOMERY AVE FL 2
BALA CYNWYD PA
19004-2827
US

IV. Provider business mailing address

PO BOX 2205
BALA CYNWYD PA
19004-6205
US

V. Phone/Fax

Practice location:
  • Phone: 610-960-8905
  • Fax: 610-667-4374
Mailing address:
  • Phone: 610-960-8905
  • Fax: 610-667-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN MELMAN
Title or Position: PRESIDENT
Credential: DMD
Phone: 610-664-7795