Provider Demographics
NPI:1629058151
Name:POWERS, LEE SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:SCOTT
Last Name:POWERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:18277 STATE ROAD A
Mailing Address - Street 2:P.O. BOX 799
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-7225
Mailing Address - Country:US
Mailing Address - Phone:573-765-5511
Mailing Address - Fax:573-765-5844
Practice Address - Street 1:122 W EST MCCLURG AVE.
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556-7225
Practice Address - Country:US
Practice Address - Phone:573-765-5118
Practice Address - Fax:573-765-5844
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0125341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice