=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265791909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW SCHAPPER D.M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2012
-----------------------------------------------------
Last Update Date | 06/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 869 NW 23RD ST
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330-4307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-750-3685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90974 S WILLAMETTE ST
-----------------------------------------------------
City | COBURG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97408-9206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-750-3685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | D9885
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------