Provider Demographics
NPI:1609477405
Name:RENSCH, BRANDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:RENSCH
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 1:415 VICK AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5025
Mailing Address - Country:US
Mailing Address - Phone:605-929-5467
Mailing Address - Fax:
Practice Address - Street 1:415 VICK AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5025
Practice Address - Country:US
Practice Address - Phone:919-787-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice