MEDICARE: DR. PHILLIP SHAWN STOPPERICH DMD

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)	DS028768L	PA

General Provider Information

NPI Number	:	1548234982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP SHAWN STOPPERICH DMD

Provider Business Mailing Address
First Line	:	100 WILHAVEN ROAD
Second Line	:	SUITE 101
City	:	MCMURRAY
State	:	PA
Zip	:	15317
Country	:	US
Telephone Number	:	724-942-4800
Fax Number	:	724-942-5767

Provider Business Practice Location Address
First Line	:	100 WILHAVEN ROAD
Second Line	:	SUITE 101
City	:	MCMURRAY
State	:	PA
Zip	:	15317
Country	:	US
Telephone Number	:	724-942-4800
Fax Number	:	724-942-5767

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	04/09/2013

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