Provider Demographics
NPI:1295873909
Name:MALLOY, DANIEL P (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:MALLOY
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 1:230 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3532
Mailing Address - Country:US
Mailing Address - Phone:414-258-2830
Mailing Address - Fax:414-258-6405
Practice Address - Street 1:230 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-3532
Practice Address - Country:US
Practice Address - Phone:414-258-2830
Practice Address - Fax:414-258-6405
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice