Healthcare Provider Details

I. General information

NPI: 1386323996
Provider Name (Legal Business Name): VALERIE MALCOLM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 CHESTER PIKE
SHARON HILL PA
19079-1411
US

IV. Provider business mailing address

417 BELGRADE ST
PHILADELPHIA PA
19125-2622
US

V. Phone/Fax

Practice location:
  • Phone: 610-583-1177
  • Fax:
Mailing address:
  • Phone: 267-818-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044096
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: