Provider Demographics
NPI:1780566299
Name:SANCTUARY ORAL MAXILLOFACIAL SURGERY
Entity type:Organization
Organization Name:SANCTUARY ORAL MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATTAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-893-3937
Mailing Address - Street 1:1650 TYSONS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4880
Mailing Address - Country:US
Mailing Address - Phone:703-893-3937
Mailing Address - Fax:215-243-7546
Practice Address - Street 1:1650 TYSONS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4880
Practice Address - Country:US
Practice Address - Phone:703-893-3937
Practice Address - Fax:215-243-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty