Provider Demographics
NPI:1700829454
Name:TEFFT, LEE SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:SCOTT
Last Name:TEFFT
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 1:1710 W WILLOW RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2438
Mailing Address - Country:US
Mailing Address - Phone:580-234-6663
Mailing Address - Fax:580-234-8051
Practice Address - Street 1:1710 W WILLOW ROAD
Practice Address - Street 2:SUITE 15
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2438
Practice Address - Country:US
Practice Address - Phone:580-234-6663
Practice Address - Fax:580-234-8051
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice