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Licensing details for: 81582

Name: WILLARD PENG DDS, INC

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

440 S. MELROSE DR SUITE 100
VISTA CA 92591
RIVERSIDE county
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Practice Location

440 S. MELROSE DR SUITE 100
VISTA CA 92591
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Issuance Date

September 1, 2023

Expiration Date

August 31, 2025

Current Date / Time

June 7, 2025
4:5:7 PM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Name: PENG, WILLARD JAMES

License/Registration Type: Dentist License

License Number: 59666 Primary Status: Current - Active

Address :
30520 Rancho California Rd
Suite #A-105
Suite#A-105
TEMECULA CA 92591-3212
RIVERSIDE COUNTY

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