Healthcare Provider Details

I. General information

NPI: 1205844610
Provider Name (Legal Business Name): REICHHELD TING ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 LITTLETON RD
WESTFORD MA
01886
US

IV. Provider business mailing address

75 ARCAND DR PROFESSIONAL PARK
LOWELL MA
01852
US

V. Phone/Fax

Practice location:
  • Phone: 978-692-5799
  • Fax: 978-692-5792
Mailing address:
  • Phone: 978-453-3872
  • Fax: 978-453-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number16880
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20259
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number16228
License Number StateMA

VIII. Authorized Official

Name: DR. BRIAN L TING
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 978-692-5799