Andrea Lynne Malcom, DH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

2000 Issued in NE

Practice address

4920 South 30TH Street
Suite 103
Omaha, NE 68107-1656

Phone

(402) 734-4110

Fax

(402) 952-1020

NPI assigned

Nov 24, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1528213121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4920 S 30TH ST",
            "address_2": "SUITE 103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071590",
            "telephone_number": "402-734-4110",
            "fax_number": "402-952-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 SOUTH 30TH STREET",
            "address_2": "SUITE 103",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681071656",
            "telephone_number": "402-734-4110",
            "fax_number": "402-952-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALCOM",
        "first_name": "ANDREA",
        "middle_name": "LYNNE",
        "credential": "DH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-24",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NE",
            "license": "2000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Malashock, OTD
• Larry D. Malashock, O.D.
• Neal H Malashock, OD
• Alexis A Malaterre, MD
• Dawn Lori Malcolm
• Kent Malcom, PLMHP
• Samantha Maldonado Salguero
• Kristina Maldonado-Hernandez
• Gina Maldonado
• Hannah Maldonado, MD

• Dental Hygienist in Omaha, NE
• Providers in Omaha, NE by specialty
• Dental Hygienist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.