| NPI | 1609418987 |
|---|---|
| Former Legal Business Name | BJB DENTAL GROUP A PROFESSIONAL DENTAL CORPORATION |
| Entity Type | Organization |
| Authorized Contact | BASSAM WISAM FARGO Co Owner/Dentist 951-329-7904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2020-03-11 |