Provider Demographics
NPI:1699897017
Name:ASHWORTH, DERWOOD LEE (DDS, MSCO)
Entity type:Individual
Prefix:DR
First Name:DERWOOD
Middle Name:LEE
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:DDS, MSCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1065
Mailing Address - Country:US
Mailing Address - Phone:336-667-4752
Mailing Address - Fax:336-667-1693
Practice Address - Street 1:110A WILKESBORO AVE
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4218
Practice Address - Country:US
Practice Address - Phone:336-667-4752
Practice Address - Fax:336-667-1693
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28801223X0400X
NC1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics