Provider Demographics
NPI:1235346750
Name:SAHAWNEH, SHOROUQ SAMEER (DDS)
Entity Type:Individual
Prefix:
First Name:SHOROUQ
Middle Name:SAMEER
Last Name:SAHAWNEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PAULARINO AVE
Mailing Address - Street 2:APT# K106
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3273
Mailing Address - Country:US
Mailing Address - Phone:714-436-1001
Mailing Address - Fax:
Practice Address - Street 1:550 PAULARINO AVE
Practice Address - Street 2:APT# K106
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3273
Practice Address - Country:US
Practice Address - Phone:714-436-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice