Healthcare Provider Details

I. General information

NPI: 1235292657
Provider Name (Legal Business Name): DARYL E. MALENA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10838 OLD MILL RD SUITE 8
OMAHA NE
68154-2649
US

IV. Provider business mailing address

10838 OLD MILL RD SUITE 8
OMAHA NE
68154-2649
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-4100
  • Fax: 402-330-4103
Mailing address:
  • Phone: 402-330-4100
  • Fax: 402-330-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3901
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: