SANCTUARY ORAL MAXILLOFACIAL SURGERY NPI 1780566299

NPI Information

  • NPI: 1780566299
  • Provider Name: SANCTUARY ORAL MAXILLOFACIAL SURGERY
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • CLIA Number: 49D2149005
  • Address: 1650 TYSONS BLVD STE 100
    MC LEAN, VA
    ZIP 22102
  • Phone: (703) 893-3937

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NPI Details

SANCTUARY ORAL MAXILLOFACIAL SURGERY is an oral and maxillofacial surgery dentist in Mc Lean, VA. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. SANCTUARY ORAL MAXILLOFACIAL SURGERY NPI is 1780566299. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1650 TYSONS BLVD STE 100
MC LEAN, VA
ZIP 22102-880
Phone: (703) 893-3937
Fax: (215) 243-7546

The provider's authorized official is Abdul Khattab .
The authorized official title is Director and has the following contact phone number (703) 893-3937.

The CLIA number assigned to this NPI record is 49D2149005 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/24/2025 and was last updated on 7/24/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryYes

What is NPI?

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This page was last updated on: 11/21/2025

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