# PRESTIGE PERIODONTICS BOWIE LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRESTIGE PERIODONTICS LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1518610781
- **Legal business name:** PRESTIGE PERIODONTICS LLC
- **Authorized official:** DR. DUANE BENNETT II DDS, MSD (MEMBER)
- **Authorized official phone:** (301) 681-4812

## Contact information

- **Practice address:** 4201 NORTHVIEW DR STE 501, BOWIE, MD 20716-2674
- **Practice address phone:** (301) 681-4812
- **Mailing address:** 4201 NORTHVIEW DR STE 501, BOWIE, MD 20716-2674
- **Mailing address phone:** (301) 681-4812

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0300X | Periodontics | — | NULL | Yes |
| 1223P0300X | Periodontics | — | — | Yes |

## Other

- **Enumeration date:** 01/28/2022
- **Last updated:** 01/28/2022