Provider Demographics
NPI:1902258379
Name:SECURE DENTAL II, LLC
Entity type:Organization
Organization Name:SECURE DENTAL II, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZISH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-345-8888
Mailing Address - Street 1:3127 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1316
Mailing Address - Country:US
Mailing Address - Phone:309-681-8888
Mailing Address - Fax:
Practice Address - Street 1:5025 UTICA RIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-345-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty