Fargo Dental Corporation
NPI #1609418987 in Fontana, California
Provider Information
- NPI Number
- 1609418987
- Entity Type
- Organization
- Organization Name
- Fargo Dental Corporation
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Oct 8, 2019
- Last Updated
- Mar 11, 2020
Practice Location
- Address
- 8275 SIERRA AVE STE 102
- City
- Fontana
- State
- California
- ZIP Code
- 92335-3557
- Phone
- (909) 823-7567
Authorized Official
- Name
- DR. BASSAM WISAM FARGO, DDS
- Title
- CO-OWNER/DENTIST
- Phone
- (951) 329-7904
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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