Organization
CALVILLO AND PENALBA DENTAL CORP.
Active
Other names
Golden West Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILBERTO ISAAC PENALBA DDS (OWNER/PRESIDENT)
(951) 675-2690
Entity
Organization
Contact information
Practice address
9922 SIERRA AVE, FONTANA, CA 92335-6721
(909) 822-4800
(909) 822-4899
Mailing address
281 HERON LN, RIVERSIDE, CA 92507-1241
(951) 675-2690
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
60504
CA
1223G0001X
General Practice Dentistry
60505
CA
Other
Enumeration date
10/08/2014
Last updated
10/08/2014
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