Healthcare Provider Details

I. General information

NPI: 1982000923
Provider Name (Legal Business Name): HAWATMEH DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 W CENTRAL AVE
BREA CA
92821-3025
US

IV. Provider business mailing address

391 W CENTRAL AVE
BREA CA
92821-3025
US

V. Phone/Fax

Practice location:
  • Phone: 714-987-6916
  • Fax: 714-987-6920
Mailing address:
  • Phone: 714-987-6916
  • Fax: 714-987-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49108
License Number StateCA

VIII. Authorized Official

Name: AYED HAWATMEH
Title or Position: OWNER
Credential: DDS
Phone: 714-987-6916