Provider Demographics
NPI:1972690683
Name:MALCA, EDWARD D (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:MALCA
Suffix:
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 1:28 BOWDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1713
Mailing Address - Country:US
Mailing Address - Phone:973-239-5400
Mailing Address - Fax:973-239-5763
Practice Address - Street 1:28 BOWDEN ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1713
Practice Address - Country:US
Practice Address - Phone:973-239-5400
Practice Address - Fax:973-239-5763
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ13717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist