| Doctor Name: | BRENDA BOSWORTH |
| NPI Number: | 1386014140 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | PHDH000015 |
| Business Practice Address: | 686 Two Mile Rd Port Allegany, PA - 167435018 |
| Business Phone Number: | 8146422732 |
| Business Fax Number: | |
| Mailing Address: | 686 Two Mile Rd, PORT ALLEGANY |
| State: | PA |
| Postal Code: | 167435018 |
| Phone Number: | 8146422732 |
| Fax Number: | |
| NPI Enumeration Date: | 10/05/2015 |
| NPI Last Update Date: | 10/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 125K00000X |
| License Number: | PHDH000015 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Advanced Practice Dental Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An Advanced Practice Dental Therapist is: (1) A dental therapist who has completed additional training beyond basic dental therapy education and provides dental services in accordance with state advanced practice dental therapist laws or statutes; or (2) A dental hygienist with a graduate degree in advanced dental therapy prepared for independent and interdependent decision making and direct accountability for clinical judgment across the dental health care continuum. The individual has been authorized by the relevant state board or a tribal entity to provide services under the remote supervision of a dentist. The functions of the advanced practice dental therapist vary based on the needs of the dentist, the educational preparation of the advanced practice dental therapist and state dental practice acts and regulations. |