Healthcare Provider Details

I. General information

NPI: 1699837542
Provider Name (Legal Business Name): GARY PHILIPP SCHOPPERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WYNDHURST AVE STE 270
BALTIMORE MD
21210-2489
US

IV. Provider business mailing address

600 WYNDHURST AVENUE SUITE 270
BALTIMORE MD
21210
US

V. Phone/Fax

Practice location:
  • Phone: 410-435-1234
  • Fax:
Mailing address:
  • Phone: 410-435-1234
  • Fax: 410-435-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4370
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: