1447635099 NPI number — SAHAWNEH DENTAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447635099 NPI number — SAHAWNEH DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAHAWNEH DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRIGHT NOW DENTAL - WILMINGTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447635099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SPECTRUM CENTER DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-578-6358
Provider Business Mailing Address Fax Number:
949-861-9868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 N AVALON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90744-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-835-3131
Provider Business Practice Location Address Fax Number:
310-835-0088
Provider Enumeration Date:
07/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SAHAWNEH
Authorized Official First Name:
SHOROUQ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
714-578-6358

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  55643 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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