Wilderness Station Pediatric Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

6492 Issued in NE

Legal business name

WILDERNESS STATION PEDIATRIC DENTISTRY

Practice address

8020 S 13TH St
Lincoln, NE 68512-9371

Phone

(402) 420-8020

Fax

(402) 420-0367

NPI assigned

Apr 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Martin D. Killeen, DDS

Title

Doctor

Phone

(402) 420-8020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419292800000",
    "number": "1568682052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8020 S 13TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685129371",
            "telephone_number": "402-420-8020",
            "fax_number": "402-420-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8020 S 13TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685129371",
            "telephone_number": "402-420-8020",
            "fax_number": "402-420-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERNESS STATION PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2014-12-23",
        "status": "A",
        "authorized_official_last_name": "KILLEEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "402-420-8020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NE",
            "license": "6492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025264500",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharon Kay Wilcox
• Colette Cailin Wilcoxen
• Wild Fig Psychotherapy, LLC
• Joshua Wild, CRNA
• Katharine Wilde, CRNA
• Ella Wiles, MD
• Melissa Marie Wiles
• Alysha Wiley
• Jolene Wiley
• Kiana Wiley

• Dental Clinic/Center in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Dental Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.