Individual
DR. VICTORIA ANNE BLACKHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1 KNEELAND ST, BOSTON, MA 02111-1527
(302) 507-3784
Mailing address
57 DWIGHT ST APT 2, BOSTON, MA 02118-3680
(302) 507-3784
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN1858465
MA
1223P0300X
Periodontics
Primary
DN1858465
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/21/2018
Last updated
03/07/2022
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