Healthcare Provider Details

I. General information

NPI: 1114573920
Provider Name (Legal Business Name): SAHAWNEH DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9851 SOUTH ALAMEDA UNIT A
LOS ANGELES CA
90002
US

IV. Provider business mailing address

100 SPECTRUM CENTER DR STE 1500
IRVINE CA
92618-4984
US

V. Phone/Fax

Practice location:
  • Phone: 323-513-1670
  • Fax:
Mailing address:
  • Phone: 714-428-1326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHOROUQ SAMEER SAHAWNEH
Title or Position: PC OWNER
Credential:
Phone: 714-578-6358