Healthcare Provider Details

I. General information

NPI: 1033729199
Provider Name (Legal Business Name): CHRISTIAN DIEGO LEPURE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 FENTON ST STE 303
CHULA VISTA CA
91914-4552
US

IV. Provider business mailing address

15677 VIA MONTECRISTO
SAN DIEGO CA
92127-4144
US

V. Phone/Fax

Practice location:
  • Phone: 619-621-5000
  • Fax:
Mailing address:
  • Phone: 915-253-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS112730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberS7-140
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: