Provider Demographics
NPI:1295818151
Name:KILLEEN, AMY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:C
Last Name:KILLEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CALUMET CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4115
Mailing Address - Country:US
Mailing Address - Phone:402-202-1174
Mailing Address - Fax:
Practice Address - Street 1:40 HOLDREGE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583
Practice Address - Country:US
Practice Address - Phone:402-472-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice