Healthcare Provider Details

I. General information

NPI: 1548024060
Provider Name (Legal Business Name): W PENG DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30630 RANCHO CALIFORNIA RD STE 504
TEMECULA CA
92591-3205
US

IV. Provider business mailing address

30630 RANCHO CALIFORNIA RD STE 504
TEMECULA CA
92591-3205
US

V. Phone/Fax

Practice location:
  • Phone: 951-694-0545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLARD PENG
Title or Position: SOLE OWNER
Credential:
Phone: 818-653-1246