Provider Demographics
NPI:1649704347
Name:HAWATMEH DENTAL GROUP PC
Entity type:Organization
Organization Name:HAWATMEH DENTAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AYED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWATMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-898-9223
Mailing Address - Street 1:1185 MAGNOLIA AVE
Mailing Address - Street 2:#K
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3218
Mailing Address - Country:US
Mailing Address - Phone:951-898-9223
Mailing Address - Fax:951-898-6985
Practice Address - Street 1:1185 MAGNOLIA AVE
Practice Address - Street 2:#K
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3218
Practice Address - Country:US
Practice Address - Phone:951-898-9223
Practice Address - Fax:951-898-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982000923Medicaid