Provider Demographics
NPI:1639480171
Name:SLOOTSKY, JODI ALYSSA (DMD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ALYSSA
Last Name:SLOOTSKY
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 1:395 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:STEELTON
Mailing Address - State:PA
Mailing Address - Zip Code:17113-2516
Mailing Address - Country:US
Mailing Address - Phone:717-939-6220
Mailing Address - Fax:
Practice Address - Street 1:395 S 3RD ST
Practice Address - Street 2:
Practice Address - City:STEELTON
Practice Address - State:PA
Practice Address - Zip Code:17113-2516
Practice Address - Country:US
Practice Address - Phone:717-939-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0384081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program