Active NPI
Brenda Bosworth
- Advanced Practice Dental Therapist
- Port Allegany, PA
National Provider Identifier
1386014140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Dental Therapist
- License
- PHDH000015
- Practice address
- 686 Two Mile Rd
Port Allegany, PA 16743-5018 - Phone
- (814) 642-2732
- NPI assigned
- Oct 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Dental Therapist | 125K00000X | PHDH000015 | PA | Primary |
Addresses
Primary practice location
686 Two Mile Rd
Port Allegany, PA 16743-5018
Mailing address
686 Two Mile Rd
Port Allegany, PA 16743-5018
Phone (814) 642-2732
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PHDH000015 | PA | MD | Advanced Practice Dental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444003200000",
"number": "1386014140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "686 TWO MILE RD",
"city": "PORT ALLEGANY",
"state": "PA",
"postal_code": "167435018",
"telephone_number": "814-642-2732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "686 TWO MILE RD",
"city": "PORT ALLEGANY",
"state": "PA",
"postal_code": "167435018",
"telephone_number": "814-642-2732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSWORTH",
"first_name": "BRENDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-05",
"last_updated": "2015-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "125K00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Dental Therapist",
"state": "PA",
"license": "PHDH000015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Allegany, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.