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General NPI Number Information
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NPI Number | 1780558536
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Entity Type | Organization
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Legal Business Name | BLOSSOM ORTHODONTICS PLLC
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 24585 STONE CARVER DR STE 250
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City | ALDIE
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State | VA
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Zip | 20105-3256
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Country | US
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Telephone | 703-423-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 24585 STONE CARVER DR STE 250
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City | ALDIE
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State | VA
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Zip | 20105-3256
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Country | US
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Telephone | 703-423-0288
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. LAM C BUI
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Credential | DMD
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Telephone | 703-929-7838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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