Provider Demographics
NPI:1518009067
Name:WORKNEH, SIRAK YARED (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIRAK
Middle Name:YARED
Last Name:WORKNEH
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 1:7300 FRANKLIN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2900
Mailing Address - Country:US
Mailing Address - Phone:916-428-4325
Mailing Address - Fax:916-428-7858
Practice Address - Street 1:7300 FRANKLIN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2900
Practice Address - Country:US
Practice Address - Phone:916-428-4325
Practice Address - Fax:916-428-7858
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB45055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4505501Medicare ID - Type UnspecifiedDENTICARE