Fargo Dental Corporation

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

FARGO DENTAL CORPORATION

Practice address

8275 Sierra Ave Ste 102
Fontana, CA 92335-3557

Phone

(909) 823-7567

Fax

(909) 823-8341

NPI assigned

Oct 8, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Bassam Wisam Fargo, DDSNPI 1649794009

Title

Co-Owner/Dentist

Phone

(951) 329-7904

Specialties & licenses 1

Addresses

Other names 1

• BJB DENTAL GROUP A PROFESSIONAL DENTAL CORPORATION Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bassam W Fargo, DDS

  • Dentist
  • Fontana, CA
  • NPI 1649794009
  NPD Authorized official
• Julie McGhee, DDS

  • Dentist
  • Fontana, CA
  • NPI 1093825168
  NPD (past)

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1609418987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8275 SIERRA AVE STE 102",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353557",
            "telephone_number": "909-823-7567",
            "fax_number": "909-823-8341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8275 SIERRA AVE STE 102",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353557",
            "telephone_number": "909-823-7567",
            "fax_number": "909-823-8341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARGO DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-08",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "FARGO",
        "authorized_official_first_name": "BASSAM",
        "authorized_official_middle_name": "WISAM",
        "authorized_official_title_or_position": "CO-OWNER/DENTIST",
        "authorized_official_telephone_number": "951-329-7904",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BJB DENTAL GROUP A PROFESSIONAL DENTAL CORPORATION",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Rekiat F Fajemisin, RDHAP
• Jessica Mary Fallon, MS
• Family Service Agency of San Bernardino
• Family Service Association
• Caroline Farag, PHARM. D.
• Bassam W Fargo, DDS
• Catherine Yang Farr
• Taylor Farr
• Kindra Faskell
• Fata Inc.

• Dental Clinic/Center in Fontana, CA
• Providers in Fontana, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.