Healthcare Provider Details

I. General information

NPI: 1366981409
Provider Name (Legal Business Name): ANDREW TALIAFERRO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W 83RD ST STE 103
PRAIRIE VILLAGE KS
66208-5120
US

IV. Provider business mailing address

11201 OUTLOOK ST APT 1281
OVERLAND PARK KS
66211-1980
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-5194
  • Fax: 913-381-5215
Mailing address:
  • Phone: 785-250-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number61947
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: