Provider Demographics
NPI:1679958219
Name:SAHAWNEH DENTAL CORPORATION
Entity type:Organization
Organization Name:SAHAWNEH DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIT
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 1:100 SPECTRUM CENTER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4962
Mailing Address - Country:US
Mailing Address - Phone:714-578-6358
Mailing Address - Fax:949-861-9868
Practice Address - Street 1:1285 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2813
Practice Address - Country:US
Practice Address - Phone:909-793-5777
Practice Address - Fax:909-335-8884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAHAWNEH DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty