Provider Demographics
NPI:1194592717
Name:BRENDON E. PRESTWICH, PLLC
Entity type:Organization
Organization Name:BRENDON E. PRESTWICH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTWICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-358-8681
Mailing Address - Street 1:1370 LITTLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4719
Mailing Address - Country:US
Mailing Address - Phone:505-358-8681
Mailing Address - Fax:
Practice Address - Street 1:6224 PORTSMOUTH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-1351
Practice Address - Country:US
Practice Address - Phone:757-500-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty