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Organization
VOGUE DENTAL LLC
Active
Organization
VOGUE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINIVAS DURSHANAPALLI (PRESEIDENT/OWNER)
(203) 215-4687
Entity
Organization
Contact information
Practice address
305 S LINDEN ST STE 101, NORMAL, IL 61761-4906
(309) 448-8889
Mailing address
305 S LINDEN ST STE 101, NORMAL, IL 61761-4906
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
08/03/2017
Last updated
09/17/2020
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