Provider Demographics
NPI:1871577767
Name:SHALOM, CYNTHIA JAKUBAS (DMD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JAKUBAS
Last Name:SHALOM
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:PSC 475 BOX 1445
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350
Mailing Address - Country:JP
Mailing Address - Phone:243-7951
Mailing Address - Fax:
Practice Address - Street 1:PSC 475 BOX 1445
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96350
Practice Address - Country:JP
Practice Address - Phone:243-7951
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics