Provider Demographics
NPI:1700931615
Name:SCHUPPER, JEFFREY LEE (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:SCHUPPER
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 1:707 HADDONFIELD BERLIN RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3714
Mailing Address - Country:US
Mailing Address - Phone:856-309-2244
Mailing Address - Fax:856-309-2247
Practice Address - Street 1:1450 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3067
Practice Address - Country:US
Practice Address - Phone:856-845-6222
Practice Address - Fax:856-853-9155
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI170541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice