Healthcare Provider Details

I. General information

NPI: 1558494963
Provider Name (Legal Business Name): ANDREW SCOTT SHALIT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 NAAMANS CREEK RD
GARNET VALLEY PA
19060-1608
US

IV. Provider business mailing address

17 CALLISON LN
VOORHEES NJ
08043-4111
US

V. Phone/Fax

Practice location:
  • Phone: 610-459-5859
  • Fax: 610-485-1782
Mailing address:
  • Phone: 856-424-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS-027736L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02016000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: