Healthcare Provider Details

I. General information

NPI: 1467707018
Provider Name (Legal Business Name): MATTHEW AARON POPPER DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 LANDERBROOK DR STE 125
CLEVELAND OH
44124
US

IV. Provider business mailing address

9024 W 102ND TER
OVERLAND PARK KS
66212-4244
US

V. Phone/Fax

Practice location:
  • Phone: 440-461-6390
  • Fax:
Mailing address:
  • Phone: 215-806-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30.025324
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2012024880
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2015020404
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number35.133569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: