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General NPI Number Information
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NPI Number | 1598050213
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Entity Type | Individual
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Provider Name | ADDISON JAMES KILLEEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 5609 S 27TH ST STE D
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City | LINCOLN
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State | NE
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Zip | 68512-1602
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Country | US
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Telephone | 402-420-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 5609 S 27TH ST STE D
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City | LINCOLN
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State | NE
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Zip | 68512-1602
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Country | US
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Telephone | 402-420-0999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6937
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License Number State | NE
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