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General NPI Number Information
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NPI Number | 1740665504
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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 | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 17003 BEAR VALLEY RD SUITE D
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City | HESPERIA
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State | CA
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Zip | 92345-1419
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Country | US
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Telephone | 760-244-1900
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Fax | 760-244-4151
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Provider Business Mailing Address
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Address Line | 100 SPECTRUM DRIVE STE 100
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City | IRVINE
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State | CA
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Zip | 92618
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Country | US
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Telephone | 714-578-6358
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Fax | 949-861-9868
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Authorized Official
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Title or Position | OWNER DOCTOR
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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 | 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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