Provider Demographics
NPI:1487347233
Name:MALCOLM, PETRICE D
Entity type:Individual
Prefix:DR
First Name:PETRICE
Middle Name:D
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 LITTLE SORRELL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7372
Mailing Address - Country:US
Mailing Address - Phone:540-214-2513
Mailing Address - Fax:
Practice Address - Street 1:3912 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5861
Practice Address - Country:US
Practice Address - Phone:844-796-2797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014192511223G0001X
DCDEN20002871223G0001X
MD181271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice