# PALM VALLEY ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689886657
- **Authorized official:** RANDALL J BLAZIC DDS MD (OWNER)
- **Authorized official phone:** (623) 935-5774

## Contact information

- **Practice address:** 1646 N LITCHFIELD ROAD, STE 130, GOODYEAR, AZ 85338
- **Practice address phone:** (623) 935-5774
- **Practice address fax:** (623) 935-6524
- **Mailing address:** 1646 N LITCHFIELD ROAD, STE 130, GOODYEAR, AZ 85338
- **Mailing address phone:** (623) 935-5774
- **Mailing address fax:** (623) 935-6524

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | M31657 | AZ | Yes |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 08/22/2020