Provider Demographics
NPI:1932858990
Name:DYCK, ASHTON (DO)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:DYCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2575
Mailing Address - Country:US
Mailing Address - Phone:916-217-5492
Mailing Address - Fax:
Practice Address - Street 1:NAVAL AIR STATION LEMOORE
Practice Address - Street 2:K ST
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245
Practice Address - Country:US
Practice Address - Phone:559-998-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61423202208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice