# BLOSSOM SMILES DENTAL ASSOCIATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407686660
- **Authorized official:** DR. ROLA OWIES DMD (OWNER)
- **Authorized official phone:** (973) 337-7444

## Contact information

- **Practice address:** 134 RIDGE RD, LYNDHURST, NJ 07071-1244
- **Practice address phone:** (973) 337-7444
- **Mailing address:** 19 MARLO RD, WAYNE, NJ 07470-6034
- **Mailing address phone:** (973) 337-7444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/02/2024
- **Last updated:** 08/02/2024