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General NPI Number Information
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NPI Number | 1699897017
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Entity Type | Individual
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Provider Name | DERWOOD LEE ASHWORTH D.D.S., M.SC.O.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 110A WILKESBORO AVE
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-4218
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Country | US
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Telephone | 336-667-4752
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Fax | 336-667-1693
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Provider Business Mailing Address
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Address Line | PO BOX 1065
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-1065
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Country | US
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Telephone | 336-667-4752
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Fax | 336-667-1693
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2880
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | NC
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