MEDICARE: SAHAWNEH DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1194313122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAHAWNEH DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	100 SPECTRUM CENTER DR STE 1500
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-4984
Country	:	US
Telephone Number	:	949-308-9792
Fax Number	:

Provider Business Practice Location Address
First Line	:	8345 LAUREL CANYON BLVD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-3809
Country	:	US
Telephone Number	:	818-351-3582
Fax Number	:

Authorized Official
Title or Position	:	PC OWNER
Name	:	DR. SHOROUQ SAMEER SAHAWNEH
Credential	:
Telephone Number	:	714-578-6358

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	01/05/2021

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