# SECURE DENTAL III LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Secure Dental Lake Station
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235733858
- **Authorized official:** DR. NAZISH HASAN JAFRI DDS (OWNER DENTIST)
- **Authorized official phone:** (815) 708-2762

## Contact information

- **Practice address:** 3820 CENTRAL AVE \# 2324, LAKE STATION, IN 46405-2380
- **Practice address phone:** (219) 962-8666
- **Mailing address:** 309 BROOKSTONE DR, EAST PEORIA, IL 61611-8300
- **Mailing address phone:** (815) 708-2762

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 11/24/2020
- **Last updated:** 11/24/2020