Healthcare Provider Details

I. General information

NPI: 1730984063
Provider Name (Legal Business Name): SAHAWANEH DENTAL CORPORATON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N LEMON AVE
WALNUT CA
91789-2338
US

IV. Provider business mailing address

330 N LEMON AVE
WALNUT CA
91789-2338
US

V. Phone/Fax

Practice location:
  • Phone: 909-594-9444
  • Fax:
Mailing address:
  • Phone: 909-594-9444
  • 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: PC OWNER
Credential: DDS
Phone: 714-578-6358