Joseph R Deatherage (NPI# 1003859117, PAC ID# 5395764278) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ORAL SURGERY.
| Nation Provider ID (NPI) | 1003859117 |
| PAC ID by PECOS | 5395764278 |
| Professional Enrollment ID | I20100511001065 |
| Full Name | Joseph R Deatherage |
| Organization Legal Name | FACE AND JAW SURGEONS PC |
| Address |
1730 Burnt Boat Dr Suite 300 Bismarck ND 58503-0886 |
| Phone Number | 7012587220 |
| Gender | M |
| Credential | DDS |
| Medical School | UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO |
| Graduation Year | 1992 |
| Primary Specialty | ORAL SURGERY |
| Group Practice PAC ID | 1153311881 |
| Number of Group Practice Members | 8 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 1730 Burnt Boat Dr, Suite 300, Bismarck, ND 58503-0886 | 7012587220 | FACE AND JAW SURGEONS PC |
| 2615 Elk Dr, Suite 3, Minot, ND 58701-1200 | 7018523421 | FACE AND JAW SURGEONS PC |
| Organization Legal Name | FACE AND JAW SURGEONS PC |
| Physicians | 8 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jonathan R Gray | Oral Surgery | Face and Jaw Surgeons PC | 4344 20th Ave S, Suite 2, Fargo, ND 58103-7436 |
| Jeremiah J Glosenger | Oral Surgery | Face and Jaw Surgeons PC | 2615 Elk Dr, Suite 3, Minot, ND 58701-1200 |
| Omar C Chahal | Oral Surgery | Face and Jaw Surgeons PC | 2845 36th Ave S, Grand Forks, ND 58201-3574 |
| Preston A Gomez | Oral Surgery | Face and Jaw Surgeons PC | 1730 Burnt Boat Dr, Suite 300, Bismarck, ND 58503-0886 |
| Tuan G Bui | Maxillofacial Surgery | Face and Jaw Surgeons PC | 4344 20th Ave S, Suite 2, Fargo, ND 58103-7436 |
| Charles A Crago | Maxillofacial Surgery | Face and Jaw Surgeons PC | 4344 20th Ave S, Suite 2, Fargo, ND 58103-7436 |
| Michael R Knoll | Oral Surgery | Face and Jaw Surgeons PC | 1730 Burnt Boat Dr, Suite 300, Bismarck, ND 58503-0886 |
| Street Address |
1730 BURNT BOAT DR SUITE 300 |
| City | BISMARCK |
| State | ND |
| Zip | 58503-0886 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Preston A Gomez | Oral Surgery | Face and Jaw Surgeons PC | 1730 Burnt Boat Dr, Suite 300, Bismarck, ND 58503-0886 |
| Michael R Knoll | Oral Surgery | Face and Jaw Surgeons PC | 1730 Burnt Boat Dr, Suite 300, Bismarck, ND 58503-0886 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John W Badinger | Chiropractic | 117 E Century Ave, Bismarck, ND 58503-0412 | |
| Krista R Heil | Optometry | Family Vision Clinic LLP | 111 E Century Ave, Bismarck, ND 58503-0412 |
| George Gero | Optometry | Family Vision Clinic LLP | 111 E Century Ave, Bismarck, ND 58503-0412 |
| Amy M Fleck | Optometry | Family Vision Clinic LLP | 111 E Century Ave, Bismarck, ND 58503-0412 |
| Robert D Shaw | Chiropractic | 1003 E Interstate Ave, Suite 5, Bismarck, ND 58503-0500 | |
| Rhonda D Dockter Jolliffe | Nurse Practitioner | Bachndoc Inc. | 1001 Gateway Ave, Bismarck, ND 58503-0508 |
| Alicia D Hansen | Occupational Therapy | Bachndoc Inc. | 1001 Gateway Ave, Bismarck, ND 58503-0508 |
| Michelle M Peake | Occupational Therapy | Bachndoc Inc. | 1001 Gateway Ave, Bismarck, ND 58503-0508 |
| Anthony Keith Mitterling | Physical Therapy | Bachndoc Inc. | 1001 Gateway Ave, Bismarck, ND 58503-0508 |
| Ryan P Koch | Chiropractic | 2600 Gateway Ave, Suite 2, Bismarck, ND 58503-0513 | |
| Find all physicians in zip 58503 | |||
| City | BISMARCK |
| Zip Code | 58503 |
| Specialty | ORAL SURGERY |
| City + Specialty | BISMARCK + ORAL SURGERY |
Please comment or provide details below to improve the information on Joseph R Deatherage.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.