Individual
JOSEPH RICHARD DEATHERAGE
Active
Individual
JOSEPH RICHARD DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
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
Update your record
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