Provider Demographics
NPI:1184130528
Name:ARCHWAY ORAL SURGERY AND DENTAL IMPLANTS
Entity type:Organization
Organization Name:ARCHWAY ORAL SURGERY AND DENTAL IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:TYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:314-328-5995
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:314-328-5996
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty