| Blossom Smile Of Woodbridge Pllc | |
|
12618 Lake Ridge Dr Woodbridge VA 22192-2335 | |
| (916) 622-2098 | |
| Not Available |
| Full Name | Blossom Smile Of Woodbridge Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12618 Lake Ridge Dr, Woodbridge, Virginia |
| Authorized Official Name and Position | Hussein Alhasan (CEO) |
| Authorized Official Contact | 9166222098 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Smile Of Woodbridge Pllc 6800 Fleetwood Rd Apt 1001 Mc Lean VA 22101-3610 Ph: (916) 622-2098 | Blossom Smile Of Woodbridge Pllc 12618 Lake Ridge Dr Woodbridge VA 22192-2335 Ph: (916) 622-2098 |
| NPI Number | 1518749423 |
|---|---|
| Provider Enumeration Date | 10/16/2023 |
| Last Update Date | 10/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518749423 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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Su-en C Thlick, Dmd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 12701 Marblestone Dr, Suite #260, Woodbridge, VA 22192 Phone: 703-670-2114 | |
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