Provider Demographics
NPI:1932253010
Name:ASHWORTH, ROGER WALTER I (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:WALTER
Last Name:ASHWORTH
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20030 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-8004
Mailing Address - Country:US
Mailing Address - Phone:916-919-1841
Mailing Address - Fax:916-371-0771
Practice Address - Street 1:102 FIFTH STREET
Practice Address - Street 2:
Practice Address - City:ARBUCKLE
Practice Address - State:CA
Practice Address - Zip Code:95912
Practice Address - Country:US
Practice Address - Phone:530-476-2219
Practice Address - Fax:530-476-2930
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice