Provider Demographics
NPI:1578793980
Name:FLETCHER, LEE SCOTT (DMD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:SCOTT
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-6206
Mailing Address - Country:US
Mailing Address - Phone:864-246-6115
Mailing Address - Fax:
Practice Address - Street 1:534 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-6206
Practice Address - Country:US
Practice Address - Phone:864-246-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice