Provider Demographics
NPI:1568862092
Name:FIALKOFF, SHALOM (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHALOM
Middle Name:
Last Name:FIALKOFF
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 1:10555 N TATUM BLVD
Mailing Address - Street 2:STE A104
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1097
Mailing Address - Country:US
Mailing Address - Phone:480-998-7775
Mailing Address - Fax:480-998-2919
Practice Address - Street 1:10555 N TATUM BLVD
Practice Address - Street 2:STE A104
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1097
Practice Address - Country:US
Practice Address - Phone:480-998-7775
Practice Address - Fax:480-998-2919
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist