Individual
RANDALL J BLAZIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
13980 W AVALON DR STE 120, GOODYEAR, AZ 85395-1404
(623) 935-5774
(623) 935-6524
Mailing address
13980 W AVALON DR STE 120, GOODYEAR, AZ 85395-1404
(623) 935-5774
(623) 935-6524
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D5976
AZ
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
M31657
AZ
Other
Enumeration date
10/11/2006
Last updated
04/22/2025
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