Healthcare Provider Details

I. General information

NPI: 1124975131
Provider Name (Legal Business Name): MRS. LAUREN GENTRY DOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 VINE ST STE 530
WINSTON SALEM NC
27101-4155
US

IV. Provider business mailing address

4515 OLIVINE LN
PFAFFTOWN NC
27040-9838
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4356
  • Fax:
Mailing address:
  • Phone: 891-494-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: