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General NPI Number Information
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NPI Number | 1124492327
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Entity Type | Organization
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Legal Business Name | TYLER C PRESTWICH DDS MS PLLC
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 1015 S BROADWAY SUITE 17
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City | MINOT
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State | ND
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Zip | 58701-4667
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Country | US
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Telephone | 701-852-2646
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 S BROADWAY SUITE 17
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City | MINOT
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State | ND
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Zip | 58701-4667
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Country | US
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Telephone | 701-852-2646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TYLER C PRESTWICH
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Credential | DDS, PHD, MS
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Telephone | 701-852-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2271
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License Number State | ND
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