Individual
DR. NINA A BLACKHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
2200 ARCH ST STE 102, PHILADELPHIA, PA 19103
(302) 723-2403
Mailing address
1123 S 23RD ST, PHILADELPHIA, PA 19146-2835
(302) 723-2403
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS039585
PA
Other
Enumeration date
04/15/2014
Last updated
04/29/2019
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