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General NPI Number Information
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NPI Number | 1558494963
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Entity Type | Individual
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Provider Name | ANDREW SCOTT SHALIT D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 1376 NAAMANS CREEK RD
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City | GARNET VALLEY
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State | PA
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Zip | 19060-1608
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Country | US
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Telephone | 610-459-5859
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Fax | 610-485-1782
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Provider Business Mailing Address
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Address Line | 17 CALLISON LN
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City | VOORHEES
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State | NJ
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Zip | 08043-4111
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Country | US
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Telephone | 856-424-7175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS-027736L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02016000
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License Number State | NJ
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