Provider Demographics
NPI:1245367580
Name:MELE, DANIEL MAURO III (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MAURO
Last Name:MELE
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W EVERGREEN AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19118
Mailing Address - Country:US
Mailing Address - Phone:215-242-9411
Mailing Address - Fax:215-242-3454
Practice Address - Street 1:40 W EVERGREEN AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19118
Practice Address - Country:US
Practice Address - Phone:215-242-9411
Practice Address - Fax:215-242-3454
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023450L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist