Provider Demographics
NPI:1639462518
Name:STROTT, JORDAN TAYLOR (DMD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:TAYLOR
Last Name:STROTT
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 1:2158 E NORRIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1938
Mailing Address - Country:US
Mailing Address - Phone:973-727-5207
Mailing Address - Fax:
Practice Address - Street 1:1625 CHESTNUT ST
Practice Address - Street 2:STE 228
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4206
Practice Address - Country:US
Practice Address - Phone:215-336-8399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
PADS0390151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program