Sergio Fabian Calleja Blanco, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901022647 Issued in MI

Practice address

7611 Little River Tpke Ste 101E
Annandale, VA 22003-2630

Phone

(703) 634-4195

NPI assigned

Jun 13, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 1, 2026 through Feb 1, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• J. Daniel Labriola DDS and David J Cantor DMD PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Annandale, VA
  • NPI 1275716581
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1255824371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W LAKE LANSING RD",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238524",
            "telephone_number": "734-353-1251",
            "fax_number": "517-337-9759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7611 LITTLE RIVER TPKE STE 101E",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032630",
            "telephone_number": "703-634-4195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLEJA BLANCO",
        "first_name": "SERGIO",
        "middle_name": "FABIAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-13",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901022647",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901022647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonora T. Burger, MSW, LCSW
• Kenneth T Burnett, MSPT
• Monica Buzzetta, PA-C
• Hyung Sik Byeon, L.AC
• Justine E Byun, M.A., CCC-SLP
• Susan Diane Campbell, APRN,BS
• Thelma A. Cannon, PHARMACIST
• Dennis Robert Cantwell
• Capital Eye Care LLC
• Capital Heartcare Center, P.C.

• Oral and Maxillofacial Surgery (Dentist) in Annandale, VA
• Providers in Annandale, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.