# FACE AND JAW SURGEONS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184667305
- **Authorized official:** JOSEPH R DEATHERAGE DMD MD (DMD MD)
- **Authorized official phone:** (701) 258-7220

## Contact information

- **Practice address:** 1140 W CAPITOL AVE, BISMARCK, ND 58501-9956
- **Practice address phone:** (701) 258-7220
- **Practice address fax:** (701) 222-2329
- **Mailing address:** 1730 BURNT BOAT DR STE 300, BISMARCK, ND 58503-0886
- **Mailing address phone:** (701) 258-7220
- **Mailing address fax:** (701) 222-2329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 06/14/2006
- **Last updated:** 04/25/2019