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Individual
DR. THAER DAIFALLAH
Active
Individual
DR. THAER DAIFALLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2009013156
MO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
2009013156
MO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
60883
KS
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
2009013156
MO
Other
Enumeration date
06/02/2009
Last updated
11/19/2020
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