Provider Demographics
NPI:1164150611
Name:SAHAWANEH DENTAL CORPORATON
Entity Type:Organization
Organization Name:SAHAWANEH DENTAL CORPORATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
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:949-308-9792
Mailing Address - Fax:
Practice Address - Street 1:12539 IMPERIAL HWY STE 202
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3106
Practice Address - Country:US
Practice Address - Phone:562-863-4775
Practice Address - Fax:562-929-8978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAHAWANEH DENTAL CORPORATON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty