Provider Demographics
NPI:1871851592
Name:SAHAWNEH DENTAL CORPORATION
Entity Type:Organization
Organization Name:SAHAWNEH DENTAL CORPORATION
Other - Org Name:BRIGHT NOW DENTAL RESEDA
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 1:19361 SATICOY ST
Mailing Address - Street 2:#A
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2360
Mailing Address - Country:US
Mailing Address - Phone:818-739-1028
Mailing Address - Fax:818-734-0278
Practice Address - Street 1:19361 SATICOY ST
Practice Address - Street 2:#A
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2360
Practice Address - Country:US
Practice Address - Phone:818-739-1028
Practice Address - Fax:818-734-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
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