| NPI | 1093281149 |
|---|---|
| Doing Business As | SECURE DENTAL PORTAGE |
| Entity Type | Organization |
| Authorized Contact | NAZISH JAFRI Dentist 309-681-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2018-10-16 |