Active NPI
Patricia Walworth, DMD
- Prosthodontics
- Ft Sam Houston, TX
National Provider Identifier
1881075737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 2901021578
- Practice address
- Brooke Army Medical Center
3551 Roger Brooke Dr
Ft Sam Houston, TX 78234 - Phone
- (210) 216-7208
- NPI assigned
- Jun 17, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901021578 | MI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 2901021578 | MI | |
| Prosthodontics | 1223P0700X | 2901021578 | MI | Primary |
Addresses
Primary practice location
Brooke Army Medical Center
3551 Roger Brooke Dr
Ft Sam Houston, TX 78234
Mailing address
Jbsa Dentac
BLDG 1029, 4070 Stanley
Ft Sam Houston, TX 78234
Other practice location 1
Air Force Postgraduate Dental School
Bldg 3352
JBSA-Lackland, TX 78236
Phone (517) 442-2011
Other practice location 2
320 E Hospital Rd
FT Gordon, GA 30905
Phone (517) 442-2011
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 |
|---|---|---|---|
| 2901021578 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722384000000",
"number": "1881075737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "JBSA DENTAC",
"address_2": "BLDG 1029, 4070 STANLEY",
"city": "FT SAM HOUSTON",
"state": "TX",
"postal_code": "78234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BROOKE ARMY MEDICAL CENTER",
"address_2": "3551 ROGER BROOKE DR",
"city": "FT SAM HOUSTON",
"state": "TX",
"postal_code": "78234",
"telephone_number": "210-216-7208"
}
],
"practiceLocations": [
{
"address_1": "Air Force Postgraduate Dental School",
"address_2": "Bldg 3352",
"address_purpose": "LOCATION",
"city": "JBSA-Lackland",
"state": "TX",
"postal_code": "78236",
"country_code": "US",
"telephone_number": "517-442-2011",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "320 E Hospital Rd",
"address_purpose": "LOCATION",
"city": "FT Gordon",
"state": "GA",
"postal_code": "30905",
"country_code": "US",
"telephone_number": "517-442-2011",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALWORTH",
"first_name": "PATRICIA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-17",
"last_updated": "2024-07-31",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901021578",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "2901021578",
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MI",
"license": "2901021578",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Sam Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.