Provider Demographics
NPI:1417016270
Name:FAERBER, THOMAS HOWARD (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HOWARD
Last Name:FAERBER
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 W 109TH ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1318
Mailing Address - Country:US
Mailing Address - Phone:913-469-8895
Mailing Address - Fax:913-469-0548
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:SUITE 118
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1318
Practice Address - Country:US
Practice Address - Phone:913-469-8895
Practice Address - Fax:913-469-0548
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23538204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U21668Medicare UPIN