Provider Demographics
NPI:1992805378
Name:LENTZ, ROBERT PRESTON (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PRESTON
Last Name:LENTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PRESTON
Other - Middle Name:
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4529 JESSUP GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410
Mailing Address - Country:US
Mailing Address - Phone:336-605-0190
Mailing Address - Fax:336-605-0930
Practice Address - Street 1:4529 JESSUP GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9407
Practice Address - Country:US
Practice Address - Phone:336-605-0190
Practice Address - Fax:336-605-0930
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29136208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC469OtherPARTNERS MEDICARE
NC51677OtherBCBS OF NC
NC8951677Medicaid
NC1200328OtherUHC
NC295046OtherMAMSI
NC80944OtherMEDCOST
F47013Medicare UPIN