Provider Demographics
NPI:1538447321
Name:JAFRI, NAZISH HASAN (DDS)
Entity type:Individual
Prefix:DR
First Name:NAZISH
Middle Name:HASAN
Last Name:JAFRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2068
Mailing Address - Country:US
Mailing Address - Phone:815-708-2762
Mailing Address - Fax:
Practice Address - Street 1:3127 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1316
Practice Address - Country:US
Practice Address - Phone:309-681-8888
Practice Address - Fax:888-293-9991
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09322122300000X
IL019028807122300000X
IN12013065A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist