Provider Demographics
NPI:1457530941
Name:PETER G. REICHL D.D.S., SC
Entity Type:Organization
Organization Name:PETER G. REICHL D.D.S., SC
Other - Org Name:EVANS & REICHL ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:REICHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:262-547-2827
Mailing Address - Street 1:2140A WEST ST. PAUL AVENUE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5905
Mailing Address - Country:US
Mailing Address - Phone:262-547-2827
Mailing Address - Fax:262-547-1269
Practice Address - Street 1:2140 W SAINT PAUL AVE STE A
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5905
Practice Address - Country:US
Practice Address - Phone:262-547-2827
Practice Address - Fax:262-547-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3354-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty