| Vogue Dental Peoria Llc | |
|
3510 N University St Ste A Peoria IL 61604-1346 | |
| (203) 215-4687 | |
| Not Available |
| Full Name | Vogue Dental Peoria Llc |
|---|---|
| Speciality | Dentist |
| Location | 3510 N University St Ste A, Peoria, Illinois |
| Authorized Official Name and Position | Srinivas R Durshanapalli (OWNER) |
| Authorized Official Contact | 2032154687 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vogue Dental Peoria Llc 3510 N University St Ste A Peoria IL 61604-1346 Ph: () - | Vogue Dental Peoria Llc 3510 N University St Ste A Peoria IL 61604-1346 Ph: (203) 215-4687 |
| NPI Number | 1265926729 |
|---|---|
| Provider Enumeration Date | 06/19/2018 |
| Last Update Date | 02/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265926729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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