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General NPI Number Information
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NPI Number | 1093884454
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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 | 11/07/2006
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 101 W IMPERIAL HWY SUITE E
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City | BREA
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State | CA
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Zip | 92821-7902
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Country | US
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Telephone | 714-988-1000
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Fax | 714-255-1754
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Provider Business Mailing Address
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Address Line | 100 SPECTRUM CENTER DR 100
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City | IRVINE
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State | CA
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Zip | 92618-4962
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Country | US
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Telephone | 714-578-6358
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Fax |
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Authorized Official
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Title or Position | SENIOR MANAGER
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Name | MRS. ARACELLY MONTENEGRO
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Credential |
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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 | 55643
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License Number State | CA
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