Provider Demographics
NPI:1902990831
Name:REICHL, PETER G (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:REICHL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2140 W SAINT PAUL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-9541
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
Practice Address - Street 2:SUITE A
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-9541
Practice Address - Country:US
Practice Address - Phone:262-547-2827
Practice Address - Fax:262-547-1269
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3354-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics