Provider Demographics
NPI:1639418312
Name:SIRAK WORKNEH DDS,INC.
Entity Type:Organization
Organization Name:SIRAK WORKNEH DDS,INC.
Other - Org Name:UNIQUE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRAK
Authorized Official - Middle Name:YARED
Authorized Official - Last Name:WORKNEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-744-9917
Mailing Address - Street 1:430 PINE ST
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2045
Mailing Address - Country:US
Mailing Address - Phone:209-744-9917
Mailing Address - Fax:
Practice Address - Street 1:430 PINE ST
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-2045
Practice Address - Country:US
Practice Address - Phone:209-744-9917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45055302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45055OtherDENTACRE