Provider Demographics
NPI:1427213172
Name:LEE, SCOTT RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RYAN
Last Name:LEE
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 1:1911 W MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6929
Mailing Address - Country:US
Mailing Address - Phone:480-838-4185
Mailing Address - Fax:480-838-8746
Practice Address - Street 1:1911 W MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6929
Practice Address - Country:US
Practice Address - Phone:480-838-4185
Practice Address - Fax:480-838-8746
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist