Provider Demographics
NPI:1568125318
Name:SAHAWNEH DENTAL CORPORATION
Entity Type:Organization
Organization Name:SAHAWNEH DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC OWNER
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 1:4910 HAMNER AVE STE 110
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-1046
Practice Address - Country:US
Practice Address - Phone:951-324-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty