Healthcare Provider Details

I. General information

NPI: 1104622034
Provider Name (Legal Business Name): VHM DENTAL LLC/DBA PROSMILE PV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 N TATUM BLVD STE 100
PHOENIX AZ
85028-1629
US

IV. Provider business mailing address

11220 N TATUM BLVD STE 100
PHOENIX AZ
85028-1629
US

V. Phone/Fax

Practice location:
  • Phone: 480-878-0318
  • Fax:
Mailing address:
  • Phone: 480-878-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

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