Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2012024880 | MO |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 30.025324 | OH |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2015020404 | MO |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 35.133569 | OH |
NPI | 1467707018 |
---|---|
Provider Name | Matthew Aaron Popper |
First Address | Overland Park, KS 66212-4244 |
Second Address | Cleveland, OH 44124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 22/08/2018 |