Provider Demographics
NPI:1194313122
Name:SAHAWNEH DENTAL CORPORATION
Entity type:Organization
Organization Name:SAHAWNEH DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOROUQ
Authorized Official - Middle Name:SAMEER
Authorized Official - Last Name:SAHAWNEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:100 SPECTRUM CENTER DR STE 1500
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4984
Mailing Address - Country:US
Mailing Address - Phone:949-308-9792
Mailing Address - Fax:
Practice Address - Street 1:8345 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3809
Practice Address - Country:US
Practice Address - Phone:818-351-3582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAHAWNEH DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty