MEDICARE: CHRISTIAN DIEGO LEPURE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	36487	TX
2	1223E0200X	Endodontics	S7-140	NV

General Provider Information

NPI Number	:	1033729199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN DIEGO LEPURE DDS

Provider Business Mailing Address
First Line	:	2745 BOTTICELLI DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3107
Country	:	US
Telephone Number	:	915-253-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	10870 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1158
Country	:	US
Telephone Number	:	702-254-6412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	11/04/2023

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