Individual
JOSEPH RICHARD DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
1730 BURNT BOAT DR STE 300, BISMARCK, ND 58503-0886
(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
2069
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2069
DENTAL LICENSE
ND
05
—
41524
—
ND
Enumeration date
06/14/2006
Last updated
05/01/2019
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