Organization
SECURE DENTAL III LLC
Active
Other names
Secure Dental Lake Station
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NAZISH HASAN JAFRI DDS (OWNER DENTIST)
(815) 708-2762
Entity
Organization
Contact information
Practice address
3820 CENTRAL AVE # 2324, LAKE STATION, IN 46405-2380
(219) 962-8666
Mailing address
309 BROOKSTONE DR, EAST PEORIA, IL 61611-8300
(815) 708-2762
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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