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Licensing details for: 862

Name: PENUMETCHA, SIREESHA

License Type: Conscious Sedation

Primary Status: Cancelled

Address of Record

4720 ELK GROVE BLVD STE #170
ELK GROVE CA 95758
SACRAMENTO county
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Issuance Date

August 28, 2013

Expiration Date

August 31, 2024

Current Date / Time

September 8, 2025
1:50:56 AM

License Relationships

CS to DDS, OMS, or SP

License/Registration Role: Conscious Sedation Permit

Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit

Name: PENUMETCHA, SIREESHA

License/Registration Type: Dentist License

License Number: 49635 Primary Status: Current - Active

Address :
4720 Elk Grove Blvd
Suite #170
ELK GROVE CA 95758-4183
SACRAMENTO COUNTY

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