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General NPI Number Information
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NPI Number | 1184130528
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Entity Type | Organization
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Legal Business Name | ARCHWAY ORAL SURGERY AND DENTAL IMPLANTS
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 16 HAMPTON VILLAGE PLZ STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2128
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Country | US
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Telephone | 314-328-5995
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Fax | 314-328-5996
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Provider Business Mailing Address
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Address Line | 16 HAMPTON VILLAGE PLZ STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2128
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Country | US
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Telephone | 314-328-5995
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Fax | 314-328-5996
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Authorized Official
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Title or Position | OWNER / SURGEON
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Name | TYMAN LOVELESS
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Credential | DMD, MD
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Telephone | 314-328-5995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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