NPI 1003859117

Joseph Richard Deatherage, DMDMD

Practitioner Oral and Maxillofacial Surgery (Dentist) Bismarck, ND

Practice location

Address: 1730 Burnt Boat Dr STE 300, Bismarck, ND 58503-0886
Phone: (701) 258-7220
Fax: (701) 222-2329

Registered specialties

Oral and Maxillofacial Surgery (Dentist) Primary

Dental Providers Taxonomy 1223S0112X Licence 2069 (ND)

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Registry record

NPI: 1003859117
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Jun 2006
Record last updated: 1 May 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.