Joseph Richard Deatherage
Oral and Maxillofacial Surgeon
1730 Burnt Boat Dr Ste 300
Bismarck
, North Dakota 58503-0886
Joseph Richard Deatherage
Oral and Maxillofacial Surgeon
1730 Burnt Boat Dr Ste 300
Bismarck
, North Dakota 58503-0886
(701) 222-2329
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About
Features
Specialties
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Joseph Richard Deatherage
- 1730 Burnt Boat Dr Ste 300
- Bismarck, ND
- Zip : 58503-0886
- Fax : (701) 222-2329
- Phone : (701) 258-7220
Second Address
- Joseph Richard Deatherage
- 1730 Burnt Boat Dr Ste 300
- Bismarck, ND
- Zip : 58503-0886
- Fax : (701) 222-2329
- Phone : (701) 258-7220
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2069 | ND |
National Provider Identifier
| NPI | 1003859117 |
|---|---|
| Provider Name | Joseph Richard Deatherage |
| First Address | Bismarck, ND 58503-0886 |
| Second Address | Bismarck, ND 58503-0886 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/06/2006 |
| Last Update Date | 01/05/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 2069 | DENTAL LICENSE (01) | ND |
| 41524 | (05) | ND |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.