Provider Demographics
NPI:1902058290
Name:SCHAIBLE, TIMOTHY ALTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALTON
Last Name:SCHAIBLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 SIERRA VISTA PLAZA
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138
Mailing Address - Country:US
Mailing Address - Phone:314-355-5700
Mailing Address - Fax:314-355-5702
Practice Address - Street 1:1544 SIERRA VISTA PLAZA
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138
Practice Address - Country:US
Practice Address - Phone:314-355-5700
Practice Address - Fax:314-355-5702
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0149571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice