Provider Demographics
NPI:1093109175
Name:BEKOFF, MALCOLM EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:EDWARD
Last Name:BEKOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4293 ROUTE 47,
Mailing Address - Street 2:BAYSIDE STATE PRISON
Mailing Address - City:LEESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08327
Mailing Address - Country:US
Mailing Address - Phone:856-785-0040
Mailing Address - Fax:856-785-2382
Practice Address - Street 1:4293 ROUTE 47
Practice Address - Street 2:BAYSIDE STATE PRISON
Practice Address - City:LEESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08327
Practice Address - Country:US
Practice Address - Phone:856-785-0040
Practice Address - Fax:856-785-2382
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D100799600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist