Provider Demographics
NPI:1235292657
Name:MALENA, DARYL E (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:E
Last Name:MALENA
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 1:10838 OLD MILL RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2649
Mailing Address - Country:US
Mailing Address - Phone:402-330-4100
Mailing Address - Fax:402-330-4103
Practice Address - Street 1:10838 OLD MILL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2649
Practice Address - Country:US
Practice Address - Phone:402-330-4100
Practice Address - Fax:402-330-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE39011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics