Healthcare Provider Details

I. General information

NPI: 1104751007
Provider Name (Legal Business Name): BLACKHURST PERIODONTICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 CENTERVILLE RD STE 205
WILMINGTON DE
19808-1664
US

IV. Provider business mailing address

2710 CENTERVILLE RD STE 205
WILMINGTON DE
19808-1664
US

V. Phone/Fax

Practice location:
  • Phone: 302-507-3784
  • Fax:
Mailing address:
  • Phone: 302-707-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTORIA BLACKHURST
Title or Position: OWNER, PERIODONTIST
Credential: D.D.S.
Phone: 302-707-6757