Provider Demographics
NPI:1508654906
Name:LEE, SCOUT CHRISTIAN
Entity type:Individual
Prefix:
First Name:SCOUT
Middle Name:CHRISTIAN
Last Name:LEE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 200TH RD
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-5193
Mailing Address - Country:US
Mailing Address - Phone:620-212-4925
Mailing Address - Fax:
Practice Address - Street 1:4000 E CAMPUS LOOP S
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-1530
Practice Address - Country:US
Practice Address - Phone:402-472-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NESTUDENT122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist