Provider Demographics
NPI:1164779187
Name:SIRENKO, SERGEY (DDS)
Entity Type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:SIRENKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15515 W SUNSET BLVD
Mailing Address - Street 2:503
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15515 W SUNSET BLVD
Practice Address - Street 2:503
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3533
Practice Address - Country:US
Practice Address - Phone:310-454-0388
Practice Address - Fax:310-230-0239
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist