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General NPI Number Information
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NPI Number | 1508654906
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Entity Type | Individual
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Provider Name | SCOUT CHRISTIAN LEE
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Gender | Male
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 4000 E CAMPUS LOOP S
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City | LINCOLN
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State | NE
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Zip | 68583-1530
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Country | US
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Telephone | 402-472-1333
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 200TH RD
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City | CHANUTE
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State | KS
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Zip | 66720-5193
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Country | US
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Telephone | 620-212-4925
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | STUDENT
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License Number State | NE
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