Provider Demographics
NPI:1114573920
Name:SAHAWNEH DENTAL CORPORATION
Entity Type:Organization
Organization Name:SAHAWNEH DENTAL CORPORATION
Other - Org Name:BRIGHT NOW DENTAL - JORDAN DOWNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOROUQ
Authorized Official - Middle Name:SAMEER
Authorized Official - Last Name:SAHAWNEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:100 SPECTRUM CENTER DR STE 1500
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4984
Mailing Address - Country:US
Mailing Address - Phone:714-428-1326
Mailing Address - Fax:
Practice Address - Street 1:9851 SOUTH ALAMEDA
Practice Address - Street 2:UNIT A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002
Practice Address - Country:US
Practice Address - Phone:323-513-1670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAHAWNEH DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-16
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty