Provider Demographics
NPI:1689686255
Name:KILLEEN, AMY MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:KILLEEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-0608
Mailing Address - Country:US
Mailing Address - Phone:301-898-5778
Mailing Address - Fax:301-898-5350
Practice Address - Street 1:29A WEST PENNSYLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793
Practice Address - Country:US
Practice Address - Phone:301-898-5778
Practice Address - Fax:301-898-5350
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD84951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice