MEDICARE: DR. TIMOTHY ALTON SCHAIBLE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	014957	MO

General Provider Information

NPI Number	:	1902058290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY ALTON SCHAIBLE D.M.D.

Provider Business Mailing Address
First Line	:	1544 SIERRA VISTA PLAZA
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63138
Country	:	US
Telephone Number	:	314-355-5700
Fax Number	:	314-355-5702

Provider Business Practice Location Address
First Line	:	1544 SIERRA VISTA PLAZA
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63138
Country	:	US
Telephone Number	:	314-355-5700
Fax Number	:	314-355-5702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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