Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 04-23538 | KS |
NPI | 1417016270 |
---|---|
Provider Name | Dr. Thomas Howard Faerber |
First Address | Overland Park, KS 66211-1318 |
Second Address | Overland Park, KS 66211-1318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U21668 | (02) |