Individual
BRENDA BOSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
686 TWO MILE RD, PORT ALLEGANY, PA 16743-5018
(814) 642-2732
Mailing address
686 TWO MILE RD, PORT ALLEGANY, PA 16743-5018
(814) 642-2732
Taxonomy
Speciality
Code
Description
License number
State
125K00000X
Advanced Practice Dental Therapist
Primary
PHDH000015
PA
Other
Enumeration date
10/05/2015
Last updated
10/05/2015
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