MEDICARE: MADLYN LAWRENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14472	NC

General Provider Information

NPI Number	:	1154194041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADLYN LAWRENCE

Provider Business Mailing Address
First Line	:	4700 BISBEE DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-9713
Country	:	US
Telephone Number	:	217-828-2687
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 CHARLOIS BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1507
Country	:	US
Telephone Number	:	336-331-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	04/06/2026

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Directions to “ MADLYN LAWRENCE ” Practice Location

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