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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1497585004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAHAWNEH DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	675 ANTON BLVD STE 500
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1919
Country	:	US
Telephone Number	:	949-308-9792
Fax Number	:

Provider Business Practice Location Address
First Line	:	31876 DEL OBISPO ST STE 103
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-3240
Country	:	US
Telephone Number	:	949-538-4250
Fax Number	:	949-535-1391

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	SHOROUQ SAMEER SAHAWNEH
Credential	:	DDS
Telephone Number	:	714-578-6358

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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