Provider Demographics
NPI:1700298338
Name:PRENTICE, JOSHUA NOLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:NOLIN
Last Name:PRENTICE
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 1:2088 NE WILLIAMSON CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3760
Mailing Address - Country:US
Mailing Address - Phone:918-520-6003
Mailing Address - Fax:
Practice Address - Street 1:2088 NE WILLIAMSON CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3760
Practice Address - Country:US
Practice Address - Phone:541-382-3691
Practice Address - Fax:541-382-1217
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD105821223G0001X
OK66041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice