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General NPI Number Information
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NPI Number | 1508993510
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Entity Type | Organization
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Legal Business Name | TIMOTHY A. SCHAIBLE P.C.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 1544 SIERRA VISTA PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63138-2040
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Country | US
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Telephone | 314-355-5700
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Fax | 314-355-5702
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Provider Business Mailing Address
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Address Line | 1544 SIERRA VISTA PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63138-2040
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Country | US
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Telephone | 314-355-5700
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Fax | 314-355-5702
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY ALTON SCHAIBLE
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Credential | DMD
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Telephone | 314-355-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14957
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License Number State | MO
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