Provider Demographics
NPI:1932487246
Name:PENALBA, WILBERTO ISAAC (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILBERTO
Middle Name:ISAAC
Last Name:PENALBA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9922 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6721
Mailing Address - Country:US
Mailing Address - Phone:909-822-4800
Mailing Address - Fax:
Practice Address - Street 1:9922 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6721
Practice Address - Country:US
Practice Address - Phone:909-822-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice