Healthcare Provider Details

I. General information

NPI: 1275250862
Provider Name (Legal Business Name): SAHAWNEH DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 LA SIERRA AVE # F1
RIVERSIDE CA
92505-3066
US

IV. Provider business mailing address

100 SPECTRUM CENTER DR STE 100
IRVINE CA
92618-4963
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-2400
  • Fax:
Mailing address:
  • Phone: 714-578-6358
  • 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: OWNER
Credential: DDS
Phone: 714-578-6358