Provider Demographics
NPI:1386323996
Name:MALCOLM, VALERIE (DMD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 BELGRADE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2622
Mailing Address - Country:US
Mailing Address - Phone:267-818-0170
Mailing Address - Fax:
Practice Address - Street 1:907 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-1411
Practice Address - Country:US
Practice Address - Phone:610-583-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist