Organization
AFFINITY DENTAL PEORIA LLC
Active
Other names
Affinity Family Dental Peoria
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVAS DURSHANAPALLI (PRESIDENT)
(203) 215-4687
Entity
Organization
Contact information
Practice address
3510 N UNIVERSITY ST STE C, PEORIA, IL 61604-1348
(309) 271-7777
(309) 324-5777
Mailing address
3510 N UNIVERSITY ST STE C, PEORIA, IL 61604-1348
(309) 271-7777
(309) 324-5777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
07/02/2024
Last updated
11/05/2024
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