Healthcare Provider Details

I. General information

NPI: 1366963530
Provider Name (Legal Business Name): TYLER WESLEY EATCHEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WASHINGTON ST
ATTLEBORO MA
02703-6948
US

IV. Provider business mailing address

883 LANDRY AVE
NORTH ATTLEBORO MA
02760-2465
US

V. Phone/Fax

Practice location:
  • Phone: 508-761-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901022182
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN10000289
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: