Provider Demographics
NPI:1982000923
Name:HAWATMEH DENTAL, PC
Entity Type:Organization
Organization Name:HAWATMEH DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWATMEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-987-6916
Mailing Address - Street 1:391 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3025
Mailing Address - Country:US
Mailing Address - Phone:714-987-6916
Mailing Address - Fax:714-987-6920
Practice Address - Street 1:391 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3025
Practice Address - Country:US
Practice Address - Phone:714-987-6916
Practice Address - Fax:714-987-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty