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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