Provider Demographics
NPI:1023190352
Name:LEUNE, SCOTT KEES ALEXANDER
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KEES ALEXANDER
Last Name:LEUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 POTRANCO RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-9609
Mailing Address - Country:US
Mailing Address - Phone:210-520-3400
Mailing Address - Fax:210-520-3424
Practice Address - Street 1:9902 POTRANCO RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-9609
Practice Address - Country:US
Practice Address - Phone:210-520-3400
Practice Address - Fax:210-520-3424
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22472OtherSTATE LICENSE
TXA0142956OtherDPS #
TXBL9492997OtherDEA #