MEDICARE: VOGUE DENTAL PEORIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1265926729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOGUE DENTAL PEORIA LLC

Provider Business Mailing Address
First Line	:	3510 N UNIVERSITY ST STE A
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 N UNIVERSITY ST STE A
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1346
Country	:	US
Telephone Number	:	203-215-4687
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SRINIVAS R DURSHANAPALLI
Credential	:	DDS
Telephone Number	:	203-215-4687

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	02/17/2021

Similar Medicare Providers

1770871147 — ZACHARY KIRKPATRICK PT
Practice Location Address:

123 W SPRING CREEK RD
EAST PEORIA, IL
61611-1346

Practice Phone: 309-282-4800
Practice Fax: 309-282-4801

1124306501 — DR. DUSTIN ROBERT BROWN PT, DPT, ATC, LAT
Practice Location Address:

123 W SPRING CREEK RD
EAST PEORIA, IL
61611-1346

Practice Phone: 309-282-4800
Practice Fax: 309-282-4801

1619362332 — ACCELERATED REHABILITATION CENTERS, LTD
Practice Location Address:

123 W SPRING CREEK RD
EAST PEORIA, IL
61611-1346

Practice Phone: 309-383-4708
Practice Fax: 309-282-4801

1356232714 — RACHEL DERICKSON
Practice Location Address:

123 W SPRING CREEK RD
EAST PEORIA, IL
61611-1346

Practice Phone: 309-282-4800
Practice Fax: 309-282-4801

1376490037 — KARA WILLIAMS
Practice Location Address:

2806 N KNOXVILLE AVE
PEORIA, IL
61604-2870

Practice Phone: 309-655-6961
Practice Fax:

1043166911 — ELAINE D MERITT
Practice Location Address:

2807 N KNOXVILLE AVE
PEORIA, IL
61604-2869

Practice Phone: 309-966-3862
Practice Fax: 309-966-3863

Directions to “VOGUE DENTAL PEORIA LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.