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Organization
VOGUE DENTAL PEORIA LLC
Active
Organization
VOGUE DENTAL PEORIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINIVAS R DURSHANAPALLI DDS (OWNER)
(203) 215-4687
Entity
Organization
Contact information
Practice address
3510 N UNIVERSITY ST STE A, PEORIA, IL 61604-1346
(203) 215-4687
Mailing address
3510 N UNIVERSITY ST STE A, PEORIA, IL 61604-1346
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
06/19/2018
Last updated
02/17/2021
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