Provider Demographics
NPI:1497585004
Name:SAHAWNEH DENTAL CORPORATION
Entity type:Organization
Organization Name:SAHAWNEH DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHOROUQ
Authorized Official - Middle Name:SAMEER
Authorized Official - Last Name:SAHAWNEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:675 ANTON BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1919
Mailing Address - Country:US
Mailing Address - Phone:949-308-9792
Mailing Address - Fax:
Practice Address - Street 1:31876 DEL OBISPO ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3240
Practice Address - Country:US
Practice Address - Phone:949-538-4250
Practice Address - Fax:949-535-1391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAHAWNEH DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty