Provider Demographics
NPI:1700134459
Name:PRESTWICH, BRENDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDON
Middle Name:
Last Name:PRESTWICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WINNOWING WAY #411
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7527
Mailing Address - Country:US
Mailing Address - Phone:614-535-8464
Mailing Address - Fax:
Practice Address - Street 1:2020 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6286
Practice Address - Country:US
Practice Address - Phone:855-897-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice