=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649704347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAWATMEH DENTAL GROUP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2017
-----------------------------------------------------
Last Update Date | 12/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1185 MAGNOLIA AVE #K
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-898-9223
-----------------------------------------------------
Fax | 951-898-6985
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1185 MAGNOLIA AVE #K
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-898-9223
-----------------------------------------------------
Fax | 951-898-6985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. AYED HAWATMEH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-898-9223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 49108
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------