Healthcare Provider Details

I. General information

NPI: 1477502177
Provider Name (Legal Business Name): MARK J. MELE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 MOUNT CARMEL AVE
GLENSIDE PA
19038-2245
US

IV. Provider business mailing address

2826 MOUNT CARMEL AVE
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 NumberDS027434-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: