# DR. THAER DAIFALLAH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1699901868
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2009013156 | MO | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 2009013156 | MO | Yes |
| 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