Healthcare Provider Details

I. General information

NPI: 1679488035
Provider Name (Legal Business Name): PROMAXSURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26425 N LAKE PLEASANT PARKWAY SUITE 110
PEORIA AZ
85383
US

IV. Provider business mailing address

8809 N VIA LA SERENA
PARADISE VALLEY AZ
85253-2145
US

V. Phone/Fax

Practice location:
  • Phone: 917-494-3850
  • Fax:
Mailing address:
  • Phone: 917-494-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. AMOGH VELANGI
Title or Position: OWNER
Credential: DDS
Phone: 917-494-3850