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General NPI Number Information
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NPI Number | 1942348107
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Entity Type | Organization
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Legal Business Name | SERGEY SIRENKO DDS A DENTAL CORPORATION
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6221 WILSHIRE BLVD #307
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City | LOS ANGELES
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State | CA
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Zip | 90048
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Country | US
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Telephone | 323-937-4014
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Fax |
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Provider Business Mailing Address
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Address Line | 15515 SUNSET BLVD #503
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272
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Country | US
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Telephone | 310-454-0388
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Fax | 310-320-0239
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Authorized Official
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Title or Position | PRESIDENT
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Name | SERGEY SIRENKO
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Credential | DDS
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Telephone | 310-454-0388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 39886
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License Number State | CA
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