Provider Demographics
NPI:1669005237
Name:DIRECT MOBILE DENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:DIRECT MOBILE DENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-664-7795
Mailing Address - Street 1:PO BOX 2205
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-6205
Mailing Address - Country:US
Mailing Address - Phone:610-960-8905
Mailing Address - Fax:610-667-4374
Practice Address - Street 1:141 MONTGOMERY AVE FL 2
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2827
Practice Address - Country:US
Practice Address - Phone:610-960-8905
Practice Address - Fax:610-667-4374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIRECT MOBILE DENTAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034415850003Medicaid