Individual
PATRICIA WALWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
BROOKE ARMY MEDICAL CENTER, 3551 ROGER BROOKE DR, FT SAM HOUSTON, TX 78234
(210) 216-7208
Mailing address
JBSA DENTAC, BLDG 1029, 4070 STANLEY, FT SAM HOUSTON, TX 78234
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901021578
MI
1223P0700X
Prosthodontics
Primary
2901021578
MI
390200000X
Student in an Organized Health Care Education/Training Program
2901021578
MI
Other
Enumeration date
06/17/2015
Last updated
07/31/2024
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