Provider Demographics
NPI:1598050213
Name:KILLEEN, ADDISON JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADDISON
Middle Name:JAMES
Last Name:KILLEEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 S 27TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1602
Mailing Address - Country:US
Mailing Address - Phone:402-420-0999
Mailing Address - Fax:
Practice Address - Street 1:5609 S 27TH ST STE D
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1602
Practice Address - Country:US
Practice Address - Phone:402-420-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice