Healthcare Provider Details

I. General information

NPI: 1194592717
Provider Name (Legal Business Name): BRENDON E. PRESTWICH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6224 PORTSMOUTH BLVD STE 300
PORTSMOUTH VA
23701-1351
US

IV. Provider business mailing address

1370 LITTLE NECK RD
VIRGINIA BEACH VA
23452-4719
US

V. Phone/Fax

Practice location:
  • Phone: 757-500-8500
  • Fax:
Mailing address:
  • Phone: 505-358-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENDON PRESTWICH
Title or Position: PRESIDENT
Credential: DDS
Phone: 505-358-8681