Provider Demographics
NPI:1730291501
Name:LEE, SCOTT SUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:SUNG
Last Name:LEE
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 1:5105 S DURANGO DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0167
Mailing Address - Country:US
Mailing Address - Phone:702-262-7900
Mailing Address - Fax:702-262-7979
Practice Address - Street 1:5105 S DURANGO DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0167
Practice Address - Country:US
Practice Address - Phone:702-262-7900
Practice Address - Fax:702-262-7979
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice