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General NPI Number Information
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NPI Number | 1790169837
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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 | 07/18/2015
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | 11001 BEACH BLVD
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City | STANTON
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State | CA
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Zip | 90680-3216
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Country | US
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Telephone | 714-891-6623
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Fax | 714-893-1504
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Provider Business Mailing Address
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Address Line | 100 SPECTRUM CENTER DR STE 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 | 949-861-9868
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Authorized Official
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Title or Position | OWNER DENTIST
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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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