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General NPI Number Information
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NPI Number | 1063773661
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Entity Type | Organization
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Legal Business Name | SAHAWNEH DENTAL CORPORATION
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 3358 S BRISTOL ST
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City | SANTA ANA
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State | CA
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Zip | 92705
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Country | US
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Telephone | 714-361-2141
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Fax | 714-979-1659
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Provider Business Mailing Address
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Address Line | 3358 S BRISTOL ST
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City | SANTA ANA
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State | CA
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Zip | 92705
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Country | US
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Telephone | 714-361-2141
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Fax | 714-979-1659
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHOROUQ SAHAWNEH
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Credential | DDS
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Telephone | 714-578-6358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 55643
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License Number State | CA
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