Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 16880-1 | MA |
NPI | 1023213956 |
---|---|
Provider Name | Dr. Stephen J Reichheld |
First Address | Westford, MA 01886-3109 |
Second Address | Westford, MA 01886-3109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 08/07/2007 |