Organization
PALM VALLEY ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL J BLAZIC DDS MD (OWNER)
(623) 935-5774
Entity
Organization
Contact information
Practice address
1646 N LITCHFIELD ROAD, STE 130, GOODYEAR, AZ 85338
(623) 935-5774
(623) 935-6524
Mailing address
1646 N LITCHFIELD ROAD, STE 130, GOODYEAR, AZ 85338
(623) 935-5774
(623) 935-6524
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
M31657
AZ
Other
Enumeration date
05/04/2007
Last updated
08/22/2020
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