MEDICARE: DR. EDWARD D MALCA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	13717	NJ

General Provider Information

NPI Number	:	1972690683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD D MALCA DMD

Provider Business Mailing Address
First Line	:	28 BOWDEN ROAD
Second Line	:
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1713
Country	:	US
Telephone Number	:	973-239-5400
Fax Number	:	973-239-5763

Provider Business Practice Location Address
First Line	:	28 BOWDEN ROAD
Second Line	:
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1713
Country	:	US
Telephone Number	:	973-239-5400
Fax Number	:	973-239-5763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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