Malcolm Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MALCOLM PEDIATRIC DENTISTRY

Practice address

163 Cadillac CT
Suite 3
Belvidere, IL 61008-1737

Phone

(815) 544-0909

Fax

(815) 544-0922

NPI assigned

Jul 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andy Joe Malcolm, DDSNPI 1033207089

Title

Pediatric Dentist

Phone

(815) 544-0909

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andy J Malcolm, DDS

  • Pediatric Dentistry
  • Belvidere, IL
  • NPI 1033207089
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185494400000",
    "number": "1538359427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 CADILLAC CT",
            "address_2": "SUITE 3",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610081737",
            "telephone_number": "815-544-0909",
            "fax_number": "815-544-0922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 CADILLAC CT",
            "address_2": "SUITE 3",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610081737",
            "telephone_number": "815-544-0909",
            "fax_number": "815-544-0922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALCOLM PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-27",
        "last_updated": "2007-07-27",
        "status": "A",
        "authorized_official_last_name": "MALCOLM",
        "authorized_official_first_name": "ANDY",
        "authorized_official_middle_name": "JOE",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "815-544-0909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas A Losure, DO
• David R Love, ATC, CSCS
• Therese Marie Lucietto-Sieradzki, M.D.
• Sarah Lyons, APN
• Clayton R. Malaker, M.D.
• Andy J Malcolm, DDS
• Maple Crest Care Centre LLC
• Linda Marie McGinnis
• Ericka McKenzie, DNP, APRN, FNP-BC
• Paula M McKenzie, PT

• Pediatric Dentistry in Belvidere, IL
• Providers in Belvidere, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.