Healthcare Provider Details

I. General information

NPI: 1205644648
Provider Name (Legal Business Name): MARK J MELE DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 MOUNT CARMEL AVENUE STE C
GLENSIDE PA
19038-2245
US

IV. Provider business mailing address

2826 MOUNT CARMEL AVENUE STE C
GLENSIDE PA
19038-2245
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-7880
  • Fax: 215-886-0848
Mailing address:
  • Phone: 215-886-7880
  • Fax: 215-886-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARK J MELE
Title or Position: DOCTOR
Credential: DMD
Phone: 215-886-7880