Organization
IVORY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDON E PRESTWICH DDS (DENTIST)
(505) 897-6889
Entity
Organization
Contact information
Practice address
5920 WHITEMAN DR NW, ALBUQUERQUE, NM 87120
(505) 897-6889
(505) 922-1319
Mailing address
5920 WHITEMAN DR NW, ALBUQUERQUE, NM 87120-2198
(505) 897-6889
(505) 922-1319
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4010
NM
Other
Enumeration date
12/12/2013
Last updated
12/12/2013
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