Provider Demographics
NPI:1558494963
Name:SHALIT, ANDREW SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SCOTT
Last Name:SHALIT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CALLISON LN
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4111
Mailing Address - Country:US
Mailing Address - Phone:856-424-7175
Mailing Address - Fax:
Practice Address - Street 1:1376 NAAMANS CREEK RD
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-1608
Practice Address - Country:US
Practice Address - Phone:610-459-5859
Practice Address - Fax:610-485-1782
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027736L122300000X
NJ22DI020160001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist