| NPI | 1811535404 |
|---|---|
| Doing Business As | SECURE DENTAL ASHLAND AVENUE |
| Entity Type | Organization |
| Authorized Contact | NAZISH HASAN JAFRI Dentist 309-681-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-12-15 |
| Last Update Date | 2019-12-15 |