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Organization
SIREESHA PENUMETCHA, DDS PC
Active
Organization
SIREESHA PENUMETCHA, DDS PC
Active
Other names
Lakepoint Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIREESHA PENUMETCHA (PRESIDENT)
(916) 691-9191
Entity
Organization
Contact information
Practice address
4720 ELK GROVE BLVD STE 170, ELK GROVE, CA 95758-4185
(916) 691-9191
Mailing address
4720 ELK GROVE BLVD STE 170, ELK GROVE, CA 95758-4185
(916) 691-9191
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/14/2022
Last updated
10/14/2022
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