Healthcare Provider Details

I. General information

NPI: 1912319542
Provider Name (Legal Business Name): CHRISTIAN BRENES VEGA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRISTIAN BRENES DDS, MS

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 N ELM ST STE 201
GREENSBORO NC
27455-2726
US

IV. Provider business mailing address

3810 N ELM ST STE 201
GREENSBORO NC
27455-2726
US

V. Phone/Fax

Practice location:
  • Phone: 336-545-4281
  • Fax:
Mailing address:
  • Phone: 336-545-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30425
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number13984
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: