Individual
DR. P.PENNY SIRIWAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S., M.S.
Contact information
Practice address
515 S BEACH BLVD, SUITE C, ANAHEIM, CA 92804-1812
(714) 527-9006
(714) 527-5681
Mailing address
515 S BEACH BLVD, SUITE C, ANAHEIM, CA 92804-1812
(714) 527-9006
(714) 527-5681
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
32994
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32994
DENTAL LICENSE
CA
05
—
B32994-01
—
CA
05
—
B32994-02
—
CA
01
—
CGP#169380
CALIFORNIA CHILDREN SERVI
CA
Enumeration date
11/01/2006
Last updated
07/09/2007
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