Organization
FARGO DENTAL CORPORATION
Active
Other names
BJB DENTAL GROUP A PROFESSIONAL DENTAL CORPORATION
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASSAM WISAM FARGO DDS (CO-OWNER/DENTIST)
(951) 329-7904
Entity
Organization
Contact information
Practice address
8275 SIERRA AVE STE 102, FONTANA, CA 92335-3557
(909) 823-7567
(909) 823-8341
Mailing address
8275 SIERRA AVE STE 102, FONTANA, CA 92335-3557
(909) 823-7567
(909) 823-8341
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/08/2019
Last updated
03/11/2020
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