Dental Board of California
Licensing details for: 59666
Name: PENG, WILLARD JAMES
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Previous Names: PENG, WILLARD J
Address of Record
30520 Rancho California Rd
Suite #A-105
Suite#A-105
TEMECULA CA 92591-3212
RIVERSIDE county
Map
License Relationships
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: A TIEU DDS AND W PENG DDS INC.
License/Registration Type: Additional Office Permit
License Number: 12080 Primary Status: Cancelled
Address :
8736 LAKE MURRAY BLVD
SUITE 108
SAN DIEGO CA 92119
SAN DIEGO COUNTY
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: WILLARD PENG DDS, INC
License/Registration Type: Additional Office Permit
License Number: 81582 Primary Status: Current - Active
Address :
440 S. MELROSE DR SUITE 100
VISTA CA 92591
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: VINEYARD DENTAL CARE DENTAL OFFICE OF W. PENG DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16773 Primary Status: Current - Active
Address :
30630 Rancho California Rd
Suite #504
TEMECULA CA 92591-3283
RIVERSIDE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: VISTA SIGNATURE DENTAL DENTAL OFFICE OF DR. WILLARD PENG
License/Registration Type: Fictitious Name Permit
License Number: 18328 Primary Status: Current - Active
Address :
440 S. MELROSE DRIVE., SUITE 100
VISTA CA 92081
SAN DIEGO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: VINEYARD DENTAL CARE DENTAL OFFICE OF W. PENG DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 14774 Primary Status: Expired
Address :
30630 RANCHO CALIFORNIA RD STE 504
TEMECULA CA 92591
RIVERSIDE COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: VISTA SIGNATURE DENTAL DENTAL OFFICE OF DR. WILLARD PENG
License/Registration Type: Fictitious Name Permit
License Number: 18328 Primary Status: Current - Active
Address :
440 S. MELROSE DRIVE., SUITE 100
VISTA CA 92081
SAN DIEGO COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: VINEYARD DENTAL CARE DENTAL OFFICE OF W. PENG DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 14774 Primary Status: Expired
Address :
30630 RANCHO CALIFORNIA RD STE 504
TEMECULA CA 92591
RIVERSIDE COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: VINEYARD DENTAL CARE DENTAL OFFICE OF W. PENG DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16773 Primary Status: Current - Active
Address :
30630 Rancho California Rd
Suite #504
TEMECULA CA 92591-3283
RIVERSIDE COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: PENG, WILLARD JAMES
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 3857 Primary Status: Current - Active
Address :
30520 Rancho California Rd
Suite #A-105
TEMECULA CA 92591-3212
RIVERSIDE COUNTY
