Healthcare Provider Details

I. General information

NPI: 1093656035
Provider Name (Legal Business Name): AIDA CAROLINA LEPE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W WELLINGTON AVE
CHICAGO IL
60657-6709
US

IV. Provider business mailing address

913 W WELLINGTON AVE
CHICAGO IL
60657-6709
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-2188
  • Fax: 773-871-6353
Mailing address:
  • Phone: 773-871-2188
  • Fax: 773-871-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number018.012594
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: