Provider Demographics
NPI:1689124018
Name:SHALOM FIALKOFF DMD PLLC
Entity Type:Organization
Organization Name:SHALOM FIALKOFF DMD PLLC
Other - Org Name:PARADISE VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALOM
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-998-7775
Mailing Address - Street 1:10555 N TATUM BLVD
Mailing Address - Street 2: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:
Practice Address - Street 1:10555 N TATUM BLVD
Practice Address - Street 2: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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0090651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty