Organization
SECURE DENTAL VI
Active
Other names
Secure Dental Ashland Avenue
Organization subpart
No
Provider details
NPI number
Authorized official
NAZISH HASAN JAFRI (DENTIST)
(309) 681-8888
Entity
Organization
Contact information
Practice address
3540 N ASHLAND AVE, CHICAGO, IL 60657-1314
(309) 606-5008
Mailing address
502 RIVERSIDE DR, EAST PEORIA, IL 61611-2068
(309) 681-8888
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/15/2019
Last updated
12/15/2019
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