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General NPI Number Information
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NPI Number | 1881075737
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Entity Type | Individual
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Provider Name | PATRICIA WALWORTH DMD
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Gender | Female
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DR
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City | FT SAM HOUSTON
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State | TX
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Zip | 78234
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Country | US
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Telephone | 210-216-7208
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Fax |
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Provider Business Mailing Address
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Address Line | JBSA DENTAC BLDG 1029, 4070 STANLEY
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City | FT SAM HOUSTON
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State | TX
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Zip | 78234
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021578
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 2901021578
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 2901021578
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License Number State | MI
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