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 |