Provider Demographics
NPI:1467574020
Name:POPPER, JASON P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:POPPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3007
Mailing Address - Country:US
Mailing Address - Phone:631-385-9400
Mailing Address - Fax:
Practice Address - Street 1:999 WALT WHITMAN RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3007
Practice Address - Country:US
Practice Address - Phone:631-385-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051411-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics