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General NPI Number Information
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NPI Number | 1639462518
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Entity Type | Individual
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Provider Name | JORDAN TAYLOR STROTT D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 1625 CHESTNUT ST STE 228
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4206
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Country | US
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Telephone | 215-336-8399
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Fax |
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Provider Business Mailing Address
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Address Line | 2158 E NORRIS ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-1938
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Country | US
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Telephone | 973-727-5207
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NJ
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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 | DS039015
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License Number State | PA
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