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Organization
SECURE DENTAL II
Active
Organization
SECURE DENTAL II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NAZISH HASAN JAFRI DDS (DENTIST)
(815) 708-2762
Entity
Organization
Contact information
Practice address
4601 16TH ST, UNIT 12, MOLINE, IL 61265-7000
(815) 708-2762
Mailing address
1695 DIVINE DR, ROCKFORD, IL 61107-5417
(815) 708-2762
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019028807
IL
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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