Individual
DR. THAER DAIFALLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2101 CHARLOTTE ST, KANSAS CITY, MO 64108-2727
(816) 404-0500
Mailing address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-0500
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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