Joseph Richard Deatherage, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2069 Issued in ND

Practice address

1730 Burnt Boat Dr Ste 300
Bismarck, ND 58503-0886

Phone

(701) 258-7220

Fax

(701) 222-2329

NPI assigned

Jun 14, 2006

Last updated

May 1, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral Surgery

Education

University of Texas Medical School at San Antonio, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Face and Jaw Surgeons PCGroup PAC ID 1153311881, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Bismarck, ND
  • NPI 1184667305
  Medicare reassignment Care Compare group NPD Authorized official
• Face & Jaw Surgeons, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Dickinson, ND
  • NPI 1730897026
  NPD Authorized official
• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Minot, ND
  • NPI 1104863505
  Authorized official Same address or phone
• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Forks, ND
  • NPI 1457420564
  NPD
• Ozark Oral Surgery Group, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Rogers, AR
  • NPI 1548635048
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556668800000",
    "number": "1003859117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 BURNT BOAT DR STE 300",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585030886",
            "telephone_number": "701-258-7220",
            "fax_number": "701-222-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 BURNT BOAT DR STE 300",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585030886",
            "telephone_number": "701-258-7220",
            "fax_number": "701-222-2329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1140 W Capitol Ave",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585011306",
            "country_code": "US",
            "telephone_number": "701-258-7220",
            "fax_number": "701-222-2329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEATHERAGE",
        "first_name": "JOSEPH",
        "middle_name": "RICHARD",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2019-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ND",
            "license": "2069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "2069",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41524",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Marie Harris Davison, ND
• Gabrielle Dawyduk
• Louise Day, LAC
• Dayrides of ND Inc (Dayrides)
• Starla Marie Deane-Stricker
• Stephanie T Debele, OTR/L
• David Allen Debuhr, R.PH.
• Decoteau Trauma-Informed Care & Practice, PLLC
• Makalie Decoteau
• Waylon Decoteau, MD

• Oral and Maxillofacial Surgery (Dentist) in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.