Provider Demographics
NPI:1518525138
Name:MARTEL, MELANIE ELIZABETH WALLACE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ELIZABETH WALLACE
Last Name:MARTEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W DEKALB PIKE STE 301
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3060
Mailing Address - Country:US
Mailing Address - Phone:484-684-7765
Mailing Address - Fax:
Practice Address - Street 1:600 W DEKALB PIKE STE 301
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3060
Practice Address - Country:US
Practice Address - Phone:484-684-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0421511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty