| Sergio Fabian Calleja Blanco, DDS | |
|
7611 Little River Tpke Ste 101e, Annandale, VA 22003-2630 | |
| (703) 634-4195 | |
| Not Available |
| Full Name | Sergio Fabian Calleja Blanco |
|---|---|
| Gender | Male |
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 7611 Little River Tpke Ste 101e, Annandale, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255824371 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901022647 (Michigan) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2901022647 (Michigan) | Primary |
| Entity Name | Mid Michigan Oral Surgery Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174516413 PECOS PAC ID: 3274504881 Enrollment ID: O20040805000351 |
| Mailing Address | Practice Location Address |
|---|---|
| Sergio Fabian Calleja Blanco, DDS 325 W Lake Lansing Rd, East Lansing, MI 48823-8524 Ph: (734) 353-1251 | Sergio Fabian Calleja Blanco, DDS 7611 Little River Tpke Ste 101e, Annandale, VA 22003-2630 Ph: (703) 634-4195 |
Dr. Eul-mo Kang, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 4540a John Marr Dr, Annandale, VA 22003 Phone: 703-333-3016 Fax: 703-333-3018 | |
Dr. Olmedo Ivan Villavicencio, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 7501 Little River Tpke Ste 105, Annandale, VA 22003 Phone: 703-354-2878 Fax: 703-354-2712 | |
Dr. Lynn M Farrey, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 4322 Ravensworth Rd, Annandale, VA 22003 Phone: 703-256-5870 | |
Dr. John Douglas Wooddell, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 3299 Woodburn Rd, Ste 440, Annandale, VA 22003 Phone: 703-698-9698 Fax: 703-849-0935 | |
Dr. Henry Insuk Park, DDS Dentist Medicare: Medicare Enrolled Practice Location: 7611 Little River Tpke, Suite 106w, Annandale, VA 22003 Phone: 703-750-0110 Fax: 703-750-1211 | |
Dr. Meghan J. Lindgren, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 4600 John Marr Dr, Annandale, VA 22003 Phone: 703-750-9393 Fax: 703-750-5420 | |
Dr. Jonathan B Vo, Dentist Medicare: Not Enrolled in Medicare Practice Location: 7519 Little River Tpke Apt T-1, Annandale, VA 22003 Phone: 571-299-0655 |