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General NPI Number Information
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NPI Number | 1568862092
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Entity Type | Individual
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Provider Name | SHALOM FIALKOFF D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 10555 N TATUM BLVD STE A104
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-1097
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Country | US
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Telephone | 480-998-7775
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Fax | 480-998-2919
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Provider Business Mailing Address
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Address Line | 10555 N TATUM BLVD STE A104
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-1097
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Country | US
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Telephone | 480-998-7775
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Fax | 480-998-2919
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D009065
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License Number State | AZ
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