# BLOSSOM SMILE OF WOODBRIDGE PLLC

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

## Provider details

- **NPI number:** 1518749423
- **Authorized official:** DR. HUSSEIN ALHASAN DDS, MSD (CEO)
- **Authorized official phone:** (916) 622-2098

## Contact information

- **Practice address:** 12618 LAKE RIDGE DR, WOODBRIDGE, VA 22192-2335
- **Practice address phone:** (916) 622-2098
- **Mailing address:** 6800 FLEETWOOD RD APT 1001, MC LEAN, VA 22101-3610
- **Mailing address phone:** (916) 622-2098

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/16/2023
- **Last updated:** 10/16/2023