Bassam W Fargo, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

101625 Issued in CA

Practice address

8275 Sierra Ave Ste 102
Fontana, CA 92335-3557

Phone

(951) 329-7904

NPI assigned

Jul 27, 2017

Last updated

Mar 11, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fargo Dental Corporation

  • Dental Clinic/Center
  • Fontana, CA
  • NPI 1609418987
  NPD Authorized official
• Bassam W. Fargo, DDS, Inc.

  • Dental Clinic/Center
  • Riverside, CA
  • NPI 1154961522
  NPD (past) Authorized official

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1649794009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11559 SPRINGWOOD CT",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925055116",
            "telephone_number": "951-329-7904"
        },
        {
            "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": "951-329-7904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARGO",
        "first_name": "BASSAM",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-27",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Mary Fallon, MS
• Family Service Agency of San Bernardino
• Family Service Association
• Caroline Farag, PHARM. D.
• Fargo Dental Corporation
• Catherine Yang Farr
• Taylor Farr
• Kindra Faskell
• Fata Inc. (Fata Acupuncture)
• Chiraz El Helou Fathy, MA, AMFT

• Dentist in Fontana, CA
• Providers in Fontana, CA by specialty
• Dentist 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.