Provider Demographics
NPI:1275654022
Name:MAHNKE, DARYLE JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARYLE
Middle Name:JOHN
Last Name:MAHNKE
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 1:144 BEYERLEIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 E MIDLAND ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-4631
Practice Address - Country:US
Practice Address - Phone:989-684-0873
Practice Address - Fax:989-684-4585
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010193151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice