| Fargo Dental Corporation | |
|
8275 Sierra Ave Ste 102 Fontana CA 92335-3557 | |
| (909) 823-7567 | |
| (909) 823-8341 |
| Full Name | Fargo Dental Corporation |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 8275 Sierra Ave Ste 102, Fontana, California |
| Authorized Official Name and Position | Bassam Wisam Fargo (CO-OWNER/DENTIST) |
| Authorized Official Contact | 9513297904 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fargo Dental Corporation 8275 Sierra Ave Ste 102 Fontana CA 92335-3557 Ph: (909) 823-7567 | Fargo Dental Corporation 8275 Sierra Ave Ste 102 Fontana CA 92335-3557 Ph: (909) 823-7567 |
| NPI Number | 1609418987 |
|---|---|
| Provider Enumeration Date | 10/08/2019 |
| Last Update Date | 03/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609418987 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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