Provider Demographics
NPI:1386993475
Name:DWIGHT D. ISENHOWARD
Entity type:Organization
Organization Name:DWIGHT D. ISENHOWARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:D
Authorized Official - Last Name:ISENHOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-774-0100
Mailing Address - Street 1:4921 CARTNER RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642
Mailing Address - Country:US
Mailing Address - Phone:336-774-0100
Mailing Address - Fax:
Practice Address - Street 1:3314 HEALY DR
Practice Address - Street 2:STE 107
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-774-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty