Provider Demographics
NPI:1912319542
Name:BRENES VEGA, CHRISTIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:BRENES VEGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:BRENES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1634 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-2607
Mailing Address - Country:US
Mailing Address - Phone:843-792-3294
Mailing Address - Fax:336-841-2667
Practice Address - Street 1:1634 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2607
Practice Address - Country:US
Practice Address - Phone:336-841-2667
Practice Address - Fax:336-841-2667
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30425122300000X
GADNF000394122300000X
NC150861390200000X
NC139841223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program