Provider Demographics
NPI:1578672192
Name:DANIELS, MELVIN JAMES (DMD)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:JAMES
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:301 OXFORD VALLEY ROAD
Mailing Address - Street 2:SUITE 1105A
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-493-7000
Mailing Address - Fax:215-493-7002
Practice Address - Street 1:301 OXFORD VALLEY ROAD
Practice Address - Street 2:SUITE 1105A
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-493-7000
Practice Address - Fax:215-493-7002
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026744L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0774792OtherBCBS
PA21026744OtherDELTA