Provider Demographics
NPI:1790177020
Name:DARYL E. MALENA
Entity Type:Organization
Organization Name:DARYL E. MALENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-330-4100
Mailing Address - Street 1:10838 OLD MILL RD STE 8
Mailing Address - Street 2:
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:
Practice Address - Street 1:10838 OLD MILL RD STE 8
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE39011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty