Provider Demographics
NPI:1548234982
Name:STOPPERICH, PHILLIP SHAWN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:SHAWN
Last Name:STOPPERICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILHAVEN ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:724-942-4800
Mailing Address - Fax:724-942-5767
Practice Address - Street 1:100 WILHAVEN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:724-942-4800
Practice Address - Fax:724-942-5767
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028768L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU74827Medicare UPIN
226500Medicare ID - Type Unspecified