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Licensing details for: 14774

Name: VINEYARD DENTAL CARE DENTAL OFFICE OF W. PENG DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

30630 RANCHO CALIFORNIA RD STE 504
TEMECULA CA 92591
RIVERSIDE county
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Practice Location

30630 RANCHO CALIFORNIA RD STE 504
TEMECULA CA 92591
RIVERSIDE county
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Issuance Date

January 29, 2019

Expiration Date

August 31, 2021

Current Date / Time

December 13, 2025
7:53:57 AM

License Relationships

FNP to DDS or OMS

License/Registration Role: Fictitious Name 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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