Randall J Blazic, DDS MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D5976 Issued in AZ

Practice address

13980 W Avalon Dr Ste 120
Goodyear, AZ 85395-1404

Phone

(623) 935-5774

Fax

(623) 935-6524

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 15, 2016 through Feb 15, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Palm Valley Oral Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Goodyear, AZ
  • NPI 1689886657

  Oral & Maxillofacial Surgery

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1497843445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13980 W AVALON DR STE 120",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853951404",
            "telephone_number": "623-935-5774",
            "fax_number": "623-935-6524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13980 W AVALON DR STE 120",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853951404",
            "telephone_number": "623-935-5774",
            "fax_number": "623-935-6524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAZIC",
        "first_name": "RANDALL",
        "middle_name": "J",
        "credential": "DDS MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "AZ",
            "license": "M31657",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D5976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Arizona, LLC
• Biomechanix Physical Therapy, PLC
• Bismark Lake LLC
• Casey Marie Blaesing, OTR/L
• Randy Bland
• Blessing Care
• Alexander Bocchi, DPT
• Bodyworx Health Studio LLC
• Carolyn Marie Boehmer
• Anthony B. Bolden, PA-C

• All providers in Goodyear, AZ
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.