Provider Demographics
NPI:1518094903
Name:TIMOTHY A. SCHAIBLE D.M.D AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:TIMOTHY A. SCHAIBLE D.M.D AND ASSOCIATES LLC
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:636-279-1633
Mailing Address - Street 1:340 MID RIVERS MALL DR
Mailing Address - Street 2:STE. 340
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1581
Mailing Address - Country:US
Mailing Address - Phone:636-279-1633
Mailing Address - Fax:636-397-8800
Practice Address - Street 1:340 MID RIVERS MALL DR
Practice Address - Street 2:STE. 340
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1581
Practice Address - Country:US
Practice Address - Phone:636-279-1633
Practice Address - Fax:636-397-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty