Randall J Blazic, DDS MD
Dentist, Oral and Maxillofacial Surgery in Goodyear, AZ. Individual provider (NPI-1).
NPI number1497843445
StatusActive
Last updated in NPPESApr 22, 2025
Details
- NPI
- 1497843445
- Entity type
- Individual (NPI-1)
- Name
- Randall J Blazic
- Credential
- DDS MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 11, 2006
- Certification date
- Apr 22, 2025
- Last updated
- Apr 22, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- Medicare opt-out
- Feb 15, 2016 to Feb 15, 2028
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | D5976 | AZ | Yes |
| 204E00000X | Oral & Maxillofacial Surgery | M31657 | AZ |
Practice location
13980 W Avalon Dr Ste 120Goodyear, AZ 85395-1404
Phone 623-935-5774 · Fax 623-935-6524
Mailing address
13980 W Avalon Dr Ste 120Goodyear, AZ 85395-1404
Phone 623-935-5774 · Fax 623-935-6524
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