Provider Demographics
NPI:1467707018
Name:POPPER, MATTHEW AARON (DDS, MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:POPPER
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9024 W 102ND TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4244
Mailing Address - Country:US
Mailing Address - Phone:215-806-4735
Mailing Address - Fax:
Practice Address - Street 1:5825 LANDERBROOK DR STE 125
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-461-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0253241223S0112X
MO20120248801223S0112X
MO2015020404204E00000X
OH35.133569204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery