Provider Demographics
NPI:1942348107
Name:SERGEY SIRENKO DDS A DENTAL CORPORATION
Entity Type:Organization
Organization Name:SERGEY SIRENKO DDS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-454-0388
Mailing Address - Street 1:15515 SUNSET BLVD
Mailing Address - Street 2:#503
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-454-0388
Mailing Address - Fax:310-320-0239
Practice Address - Street 1:6221 WILSHIRE BLVD
Practice Address - Street 2:#307
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:323-937-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty