Healthcare Provider Details

I. General information

NPI: 1649704347
Provider Name (Legal Business Name): HAWATMEH DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 MAGNOLIA AVE #K
CORONA CA
92879-3218
US

IV. Provider business mailing address

1185 MAGNOLIA AVE #K
CORONA CA
92879-3218
US

V. Phone/Fax

Practice location:
  • Phone: 951-898-9223
  • Fax: 951-898-6985
Mailing address:
  • Phone: 951-898-9223
  • Fax: 951-898-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AYED HAWATMEH
Title or Position: CEO
Credential:
Phone: 951-898-9223