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
2615 ELK DR, SUITE 3, MINOT, ND 58701-1200
(701) 852-3421
(701) 838-1842
Mailing address
2615 ELK DR, SUITE 3, MINOT, ND 58701-1200
(701) 852-3421
(701) 838-1842
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41328
—
ND
Enumeration date
06/02/2006
Last updated
06/08/2017
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