Dental Board of California
Licensing details for: 6317
Name: LAKEPOINT DENTAL PRACTICE OF DR. SIREESHA PENUMETCHA
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Previous Names: LAKEPOINT DENTAL
Address of Record
4720 ELK GROVE BLVD
ELK GROVE CA 95758
SACRAMENTO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PENUMETCHA, SIREESHA
Address Not Disclosed
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery 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
