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General NPI Number Information
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NPI Number | 1114573920
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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 | 08/16/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 9851 SOUTH ALAMEDA UNIT A
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City | LOS ANGELES
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State | CA
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Zip | 90002
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Country | US
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Telephone | 323-513-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SPECTRUM CENTER DR STE 1500
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City | IRVINE
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State | CA
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Zip | 92618-4984
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Country | US
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Telephone | 714-428-1326
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Fax |
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Authorized Official
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Title or Position | PC OWNER
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Name | DR. SHOROUQ SAMEER SAHAWNEH
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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