Provider Demographics
NPI:1396764171
Name:LEE, SCOTT WARREN (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WARREN
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 1:813 W COURT ST S STE 3
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2820
Mailing Address - Country:US
Mailing Address - Phone:928-428-7095
Mailing Address - Fax:928-348-0506
Practice Address - Street 1:813 W COURT ST S STE 3
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2820
Practice Address - Country:US
Practice Address - Phone:928-428-7095
Practice Address - Fax:928-348-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice