Provider Demographics
NPI:1053056739
Name:SHALIT-SCRIPTUNAS, JORDYN TAYLOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDYN
Middle Name:TAYLOR
Last Name:SHALIT-SCRIPTUNAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2302
Mailing Address - Country:US
Mailing Address - Phone:856-433-6045
Mailing Address - Fax:
Practice Address - Street 1:3501 NJ-42
Practice Address - Street 2:#270
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-740-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02910901122300000X
390200000X
NJ22DI02910900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program