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Organization
FACE AND JAW SURGEONS PC
Active
Organization
FACE AND JAW SURGEONS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH R DEATHERAGE DMD MD (DMD MD)
(701) 258-7220
Entity
Organization
Contact information
Practice address
1140 W CAPITOL AVE, BISMARCK, ND 58501-9956
(701) 258-7220
(701) 222-2329
Mailing address
1730 BURNT BOAT DR STE 300, BISMARCK, ND 58503-0886
(701) 258-7220
(701) 222-2329
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
06/14/2006
Last updated
04/25/2019
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