Organization
WILDERNESS STATION PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN D. KILLEEN DDS (DOCTOR)
(402) 420-8020
Entity
Organization
Contact information
Practice address
8020 S 13TH ST, LINCOLN, NE 68512-9371
(402) 420-8020
(402) 420-0367
Mailing address
8020 S 13TH ST, LINCOLN, NE 68512-9371
(402) 420-8020
(402) 420-0367
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6492
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025264500
—
NE
Enumeration date
04/26/2007
Last updated
12/23/2014
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