Provider Demographics
NPI:1609132745
Name:SAHAWNEH DENTAL CORPORATION
Entity Type:Organization
Organization Name:SAHAWNEH DENTAL CORPORATION
Other - Org Name:BRIGHTNOW DENTAL LAVERNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOROUQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHAWNEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:2497 FOOTHILL BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3066
Mailing Address - Country:US
Mailing Address - Phone:909-451-0329
Mailing Address - Fax:909-596-6026
Practice Address - Street 1:2497 FOOTHILL BLVD
Practice Address - Street 2:STE 3
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3066
Practice Address - Country:US
Practice Address - Phone:909-451-0329
Practice Address - Fax:909-596-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55643122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty