Healthcare Provider Details

I. General information

NPI: 1093884454
Provider Name (Legal Business Name): SAHAWNEH DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W IMPERIAL HWY SUITE E
BREA CA
92821-7902
US

IV. Provider business mailing address

100 SPECTRUM CENTER DR 100
IRVINE CA
92618-4962
US

V. Phone/Fax

Practice location:
  • Phone: 714-988-1000
  • Fax: 714-255-1754
Mailing address:
  • Phone: 714-578-6358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55643
License Number StateCA

VIII. Authorized Official

Name: MRS. ARACELLY MONTENEGRO
Title or Position: SENIOR MANAGER
Credential:
Phone: 714-578-6358