| Wilderness Station Pediatric Dentistry | |
|
8020 S 13th St Lincoln NE 68512-9371 | |
| (402) 420-8020 | |
| (402) 420-0367 |
| Full Name | Wilderness Station Pediatric Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 8020 S 13th St, Lincoln, Nebraska |
| Authorized Official Name and Position | Martin D. Killeen (DOCTOR) |
| Authorized Official Contact | 4024208020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilderness Station Pediatric Dentistry 8020 S 13th St Lincoln NE 68512-9371 Ph: (402) 420-8020 | Wilderness Station Pediatric Dentistry 8020 S 13th St Lincoln NE 68512-9371 Ph: (402) 420-8020 |
| NPI Number | 1568682052 |
|---|---|
| Provider Enumeration Date | 04/26/2007 |
| Last Update Date | 12/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568682052 | NPI | - | NPPES |
| 10025264500 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 6492 (Nebraska) | Primary |
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