Vogue Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

VOGUE DENTAL LLC

Practice address

305 S Linden St Ste 101
Normal, IL 61761-4906

Phone

(309) 448-8889

NPI assigned

Aug 3, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Srinivas Durshanapalli

Title

Preseident/Owner

Phone

(203) 215-4687

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brett Donovan Leavey

  • General Practice Dentistry
  • Springfield, IL
  • NPI 1114599107
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1780109470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 S LINDEN ST STE 101",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617614906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S LINDEN ST STE 101",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617614906",
            "telephone_number": "309-448-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VOGUE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-03",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "DURSHANAPALLI",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "PRESEIDENT/OWNER",
        "authorized_official_telephone_number": "203-215-4687",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Clare Vermaat, MS, LPC, LCPC
• Jodi Lynn Vermillion, M.A, BCBA
• Heidi Renee Verticchio, MS, CCC-SLP
• Zeus Tadije Villanueva, PT
• Jane Vogel, PT
• Amit Vyas, MD
• Smita Vyas, MD
• Wal-Mart Stores, Inc
• Stephan V Walchuk, MD
• Walgreen Co

• Dentist in Normal, IL
• Providers in Normal, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.