Provider Demographics
NPI:1932281680
Name:PENG DENTAL CORP
Entity Type:Organization
Organization Name:PENG DENTAL CORP
Other - Org Name:ADELANTO DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENHONG
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-530-9941
Mailing Address - Street 1:11301 W OLYMPIC BLVD # 702
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1653
Mailing Address - Country:US
Mailing Address - Phone:310-308-3204
Mailing Address - Fax:760-530-0944
Practice Address - Street 1:12100 PALMDALE RD STE B6
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-6709
Practice Address - Country:US
Practice Address - Phone:760-530-9941
Practice Address - Fax:760-530-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46124261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental