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General NPI Number Information
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NPI Number | 1548324098
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Entity Type | Organization
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Legal Business Name | HENRY C SCHUPPERT DDS, MS. PC.
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 2835 N SHEFFIELD AVE SUITE 102
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City | CHICAGO
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State | IL
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Zip | 60657-5191
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Country | US
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Telephone | 773-929-5000
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Fax | 773-929-3385
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Provider Business Mailing Address
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Address Line | 2835 N SHEFFIELD AVE SUITE 102
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City | CHICAGO
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State | IL
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Zip | 60657-5191
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Country | US
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Telephone | 773-929-5000
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Fax | 773-929-3385
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Authorized Official
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Title or Position | OWNER
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Name | DR. HENRY C SCHUPPERT
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Credential | DDS., MS.
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Telephone | 773-929-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021.002304
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License Number State | IL
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