Willard Peng, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

59666 Issued in CA

Practice address

30520 Rancho California Road,
Suite A105
Temecula, CA 92591-3282

Phone

(951) 694-0545

Fax

(951) 694-5654

NPI assigned

Sep 30, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1548544117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30520 RANCHO CALIFORNIA ROAD,",
            "address_2": "SUITE A105",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925913282",
            "telephone_number": "951-694-0545",
            "fax_number": "951-694-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30520 RANCHO CALIFORNIA ROAD,",
            "address_2": "SUITE A105",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925913282",
            "telephone_number": "951-694-0545",
            "fax_number": "951-694-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENG",
        "first_name": "WILLARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-30",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "59666",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59666",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Marlene Pedneault, FNP
• Janice Peguero
• Jessica Pena
• Nancy Maria Penaloza, LCSW
• Roy Pendleton Jr.
• Kevin Penland
• Jennifer Renee Pepka
• Perceptual Truths Marriage and Family Therapy Inc
• Dawn Percer
• Dylan Perese

• Oral and Maxillofacial Surgery (Dentist) in Temecula, CA
• Providers in Temecula, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.