Provider Demographics
NPI:1508993510
Name:TIMOTHY A. SCHAIBLE P.C.
Entity Type:Organization
Organization Name:TIMOTHY A. SCHAIBLE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:SCHAIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-355-5700
Mailing Address - Street 1:1544 SIERRA VISTA PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2040
Mailing Address - Country:US
Mailing Address - Phone:314-355-5700
Mailing Address - Fax:314-355-5702
Practice Address - Street 1:1544 SIERRA VISTA PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2040
Practice Address - Country:US
Practice Address - Phone:314-355-5700
Practice Address - Fax:314-355-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty