Active NPI
Joan S Malcolm, DDS
- General Practice Dentistry
- Sicklerville, NJ
National Provider Identifier
1154655959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22DI01975700
- Practice address
- 402 Independence Blvd
Sicklerville, NJ 08081-1094 - Phone
- (856) 875-8775
- Fax
- (856) 875-8717
- NPI assigned
- Sep 25, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22DI01975700 | NJ | Primary |
Addresses
Primary practice location
402 Independence Blvd
Sicklerville, NJ 08081-1094
Mailing address
402 Independence Blvd
Sicklerville, NJ 08081-1094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI01975700 | NJ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brightsmiles Family Dentistry LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Sicklerville, NJ
- NPI 1043413735
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253836800000",
"number": "1154655959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 INDEPENDENCE BLVD",
"city": "SICKLERVILLE",
"state": "NJ",
"postal_code": "080811094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 INDEPENDENCE BLVD",
"city": "SICKLERVILLE",
"state": "NJ",
"postal_code": "080811094",
"telephone_number": "856-875-8775",
"fax_number": "856-875-8717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALCOLM",
"first_name": "JOAN",
"middle_name": "S",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-25",
"last_updated": "2009-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI01975700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sicklerville, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.