Dental Board of California
Licensing details for: 49635
Name: PENUMETCHA, SIREESHA
License Type: Dentist
Primary Status: Current - Active
Address of Record
4720 Elk Grove Blvd
Suite #170
ELK GROVE CA 95758-4183
SACRAMENTO county
Map
License Relationships
CS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Conscious Sedation Permit
Name: PENUMETCHA, SIREESHA
License/Registration Type: Conscious Sedation Permit
License Number: 862 Primary Status: Cancelled
Address :
4720 ELK GROVE BLVD STE #170
ELK GROVE CA 95758
SACRAMENTO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: LAKEPOINT DENTAL, PRACTICE OF SIREESHA PENUMETCHA, DDS, PC.
License/Registration Type: Fictitious Name Permit
License Number: 9159 Primary Status: Current - Active
Address :
4720 ELK GROVE BOULEVARD
STE. 170
ELK GROVE CA 95758
SACRAMENTO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: LAKEPOINT DENTAL PRACTICE OF DR. SIREESHA PENUMETCHA
License/Registration Type: Fictitious Name Permit
License Number: 6317 Primary Status: Cancelled
Address :
4720 ELK GROVE BLVD
ELK GROVE CA 95758
SACRAMENTO COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: LAKEPOINT DENTAL, PRACTICE OF SIREESHA PENUMETCHA, DDS, PC.
License/Registration Type: Fictitious Name Permit
License Number: 9159 Primary Status: Current - Active
Address :
4720 ELK GROVE BOULEVARD
STE. 170
ELK GROVE CA 95758
SACRAMENTO COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: LAKEPOINT DENTAL PRACTICE OF DR. SIREESHA PENUMETCHA
License/Registration Type: Fictitious Name Permit
License Number: 6317 Primary Status: Cancelled
Address :
4720 ELK GROVE BLVD
ELK GROVE CA 95758
SACRAMENTO COUNTY
MS to DDS or OMS or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Moderate Sedation Permit
Name: PENUMETCHA, SIREESHA
License/Registration Type: Moderate Sedation Permit
License Number: 524 Primary Status: Current - Active
Address :
4720 ELK GROVE BLVD STE 170
DR SIREESHA PENUMETCHA
ELK GROVE CA 95758-4185
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: PENUMETCHA, SIREESHA
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 2329 Primary Status: Cancelled
Address :
4720 ELK GROVE BLVD STE #170
ELK GROVE CA 95758
SACRAMENTO COUNTY
PMS to DDS or OMS or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Pediatric Minimal Sedation Permit
Name: PENUMETCHA, SIREESHA
License/Registration Type: Pediatric Minimal Sedation Permit
License Number: 347 Primary Status: Current - Active
Address :
4720 ELK GROVE BLVD STE 170
ELK GROVE CA 95758-4185
