PALM VALLEY ORAL SURGERY (NPI# 1689886657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689886657 |
| Entity Type | Organization |
| Organization Name | PALM VALLEY ORAL SURGERY |
| Practice Address |
1646 N Litchfield Road Ste 130 Goodyear AZ 85338 |
| Practice Telephone | 6239355774 |
| Practice Fax Number | 6239356524 |
| Mailing Telephone | 6239355774 |
| Mailing Fax Number | 6239356524 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RANDALL J BLAZIC (OWNER) |
| Authorized Official Telephone | 6239355774 |
| Authorized Official Credential | DDS MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | M31657 | AZ | Allopathic & Osteopathic Physicians |
| Street Address |
1646 N LITCHFIELD ROAD STE 130 |
| City | GOODYEAR |
| State | AZ |
| Zip Code | 85338 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497843445 | Randall J Blazic | Dentist | 1646 N Litchfield Road, Suite 130, Goodyear, AZ 85338 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295226884 | Caroline Chang | Dentist | 15530 W Roosevelt St Ste E106, Goodyear, AZ 85338 | 2018-05-20 |
| 1609376714 | Rosanna Alvarez | Licensed Practical Nurse | 17432 W Elaine Dr, Goodyear, AZ 85338 | 2018-02-15 |
| 1023534419 | Jennifer Elizabeth Lawrence Dixon | Social Worker | 319 N Lichfield Rd, Suite 105, Goodyear, AZ 85338 | 2017-08-17 |
| 1346774916 | Vanessa Castillo | Specialist/Technologist | 18035 W. Yuma Rd, Goodyear, AZ 85338 | 2017-04-20 |
| 1386008076 | Hope Behavioral Health Residential Care | Substance Abuse Rehabilitation Facility | 15985 W.williams Street, Goodyear, AZ 85338 | 2016-04-08 |
| 1952760241 | Jeremy John Abdul-haqq | Dentist | 15661 W Roosevelt St Ste 102, Goodyear, AZ 85338 | 2016-02-16 |
| 1417206897 | Kelly Renee Filo | Occupational Therapy Assistant | 10189 S. Hacienda Dr., Goodyear, AZ 85338 | 2012-08-31 |
| 1194015545 | Nancy Ann Amore | Licensed Practical Nurse | 15578 W Yuma Road, Goodyear, AZ 85338 | 2011-04-19 |
| 1932409208 | Chung Counihan | Pharmacist | 9890 S Estrella Parkway, Goodyear, AZ 85338 | 2010-11-02 |
| 1053611327 | Traven Anderson | Pharmacist | 9890 South Estrella Parkway, Goodyear, AZ 85338 | 2010-11-02 |
| Find all providers in zip 85338 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629546171 | San Tan Valley Oral Facial and Implant Surgery Pllc | Oral & Maxillofacial Surgery | 36327 N Gantzel Rd, Suite 102, San Tan Valley, AZ 85140 | 2018-11-02 |
| 1881189199 | Desert Valley Oral Surgery | Oral & Maxillofacial Surgery | 2915 E. Baseline Road, Suite 106, Gilbert, AZ 85234 | 2018-06-28 |
| 1982873311 | Arizona Oral Facial and Implant Surgery LLC | Oral & Maxillofacial Surgery | 2450 W Ray Rd Ste 1, Chandler, AZ 85224-3595 | 2008-02-29 |
| 1538358189 | Mark D. Pogue, M.d. D.d.s., P.C. | Oral & Maxillofacial Surgery | 8535 E Hartford Dr Ste 100, Scottsdale, AZ 85255-5443 | 2007-10-19 |
| 1114125267 | Associates In Oral and Maxillofacial Surgery Pllc | Oral & Maxillofacial Surgery | 3150 N Swan, Tucson, AZ 85712 | 2007-07-10 |
| 1861528465 | Sabah Kalamchi | Oral & Maxillofacial Surgery | 8112 N 87th Pl, Scottsdale, AZ 85258-4335 | 2007-02-26 |
| 1710025044 | Angelle M Casagrande | Oral & Maxillofacial Surgery | 3150 N Swan Road, Tucson, AZ 85712 | 2007-02-01 |
| 1619026564 | Woodlands Oral & Maxillofacial Surgery PC | Oral & Maxillofacial Surgery | 1635 S Plaza Way, Flagstaff, AZ 86001-7102 | 2007-01-09 |
| 1114940335 | Nish S Shah | Oral & Maxillofacial Surgery | 2450 W Ray Rd, Ste 1, Chandler, AZ 85224 | 2006-07-26 |
| 1255327169 | Mark Pogue | Oral & Maxillofacial Surgery | 8535 E Hartford Dr, Scottsdale, AZ 85255-5438 | 2005-09-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.