Provider Demographics
NPI:1881187995
Name:HAWATMEH DENTAL GROUP PC
Entity Type:Organization
Organization Name:HAWATMEH DENTAL GROUP PC
Other - Org Name:BRAVO DENTAL GROUP OF HEMET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AYED
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAWATMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-483-1379
Mailing Address - Street 1:1300 E FLORIDA AVE # A20
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8640
Mailing Address - Country:US
Mailing Address - Phone:951-765-5544
Mailing Address - Fax:951-765-5511
Practice Address - Street 1:1300 E FLORIDA AVE # A20
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8640
Practice Address - Country:US
Practice Address - Phone:951-765-5544
Practice Address - Fax:951-765-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty