Provider Demographics
NPI:1699837542
Name:SCHOPPERT, GARY PHILIPP (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:PHILIPP
Last Name:SCHOPPERT
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 1:600 WYNDHURST AVENUE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210
Mailing Address - Country:US
Mailing Address - Phone:410-435-1234
Mailing Address - Fax:410-435-5090
Practice Address - Street 1:600 WYNDHURST AVE
Practice Address - Street 2:STE 270
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2489
Practice Address - Country:US
Practice Address - Phone:410-435-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist