MEDICARE: MATTHEW AARON POPPER DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30.025324	OH
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2012024880	MO
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	2015020404	MO
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	35.133569	OH

General Provider Information

NPI Number	:	1467707018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW AARON POPPER DDS, MD

Provider Business Mailing Address
First Line	:	9024 W 102ND TER
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66212-4244
Country	:	US
Telephone Number	:	215-806-4735
Fax Number	:

Provider Business Practice Location Address
First Line	:	5825 LANDERBROOK DR STE 125
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124
Country	:	US
Telephone Number	:	440-461-6390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	08/22/2018

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