Provider Demographics
NPI:1881942340
Name:ISENHOWARD, DWIGHT
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:
Last Name:ISENHOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 HEALY DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1408
Mailing Address - Country:US
Mailing Address - Phone:336-774-0100
Mailing Address - Fax:336-774-0102
Practice Address - Street 1:3314 HEALY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1408
Practice Address - Country:US
Practice Address - Phone:336-774-0100
Practice Address - Fax:336-774-0102
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1144237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist