Provider Demographics
NPI:1548272875
Name:BLACKMAN, WILBERT WORTH (DDS)
Entity type:Individual
Prefix:DR
First Name:WILBERT
Middle Name:WORTH
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 STATESVILLE BLVD
Mailing Address - Street 2:#230
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147
Mailing Address - Country:US
Mailing Address - Phone:704-633-1322
Mailing Address - Fax:
Practice Address - Street 1:2440 STATESVILLE BLVD
Practice Address - Street 2:#230
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147
Practice Address - Country:US
Practice Address - Phone:704-633-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U35475Medicare UPIN