Individual
DR. MICHAEL LAWRENCE BLACKHURST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
160 S BROADWAY, PENNSVILLE, NJ 08070-2220
(856) 678-5124
(856) 678-8637
Mailing address
160 S BROADWAY, PENNSVILLE, NJ 08070-2220
(856) 678-5124
(856) 678-8637
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DIO1828800
NJ
1223G0001X
General Practice Dentistry
G10001062
DE
Other
Enumeration date
05/10/2007
Last updated
07/08/2007
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