MEDICARE: LEPE DENTAL CORPORATION

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	41456	CA

General Provider Information

NPI Number	:	1154357606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEPE DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	513 SAN FERNANDO MISSION BLVD
Second Line	:
City	:	SAN FERNANDO
State	:	CA
Zip	:	91340-3933
Country	:	US
Telephone Number	:	818-365-6463
Fax Number	:	818-365-0663

Provider Business Practice Location Address
First Line	:	513 SAN FERNANDO MISSION BLVD
Second Line	:
City	:	SAN FERNANDO
State	:	CA
Zip	:	91340-3933
Country	:	US
Telephone Number	:	818-365-6463
Fax Number	:	818-365-0663

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARLOS LEPE
Credential	:	D.D.S.
Telephone Number	:	818-365-6463

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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