Provider Demographics
NPI:1578707568
Name:LOVELESS, TYMAN (DMD, MD)
Entity Type:Individual
Prefix:
First Name:TYMAN
Middle Name:
Last Name:LOVELESS
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HAMPTON VILLAGE PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2128
Mailing Address - Country:US
Mailing Address - Phone:314-328-5995
Mailing Address - Fax:
Practice Address - Street 1:16 HAMPTON VILLAGE PLZ STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2128
Practice Address - Country:US
Practice Address - Phone:314-328-5995
Practice Address - Fax:314-328-5996
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140060321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery