Healthcare Provider Details

I. General information

NPI: 1164150611
Provider Name (Legal Business Name): SAHAWANEH DENTAL CORPORATON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12539 IMPERIAL HWY STE 202
NORWALK CA
90650-3106
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 562-863-4775
  • Fax: 562-929-8978
Mailing address:
  • Phone: 949-308-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHOROUQ SAMEER SAHAWNEH
Title or Position: DDS
Credential:
Phone: 714-578-6358