Dental Board of California
Licensing details for: 18328
Name: VISTA SIGNATURE DENTAL DENTAL OFFICE OF DR. WILLARD PENG
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PENG, WILLARD JAMES
Address Not Disclosed
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
