Face and Jaw Surgeons PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

FACE AND JAW SURGEONS PC

Practice address

2615 Elk Dr
Suite 3
Minot, ND 58701-1200

Phone

(701) 852-3421

Fax

(701) 838-1842

NPI assigned

Jun 2, 2006

Last updated

Jun 8, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joseph R Deatherage, DMD MDNPI 1003859117

Title

DMD MD

Phone

(701) 258-7220

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Face & Jaw Surgeons, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Dickinson, ND
  • NPI 1730897026

  O20040514000837

  Same enrollment
• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Bismarck, ND
  • NPI 1184667305

  O20040514000837

  Same enrollment
• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fargo, ND
  • NPI 1295804300

  O20040514000837

  Same enrollment
• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Jamestown, ND
  • NPI 1396343737

  O20040514000837

  Same enrollment
• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Forks, ND
  • NPI 1457420564

  O20040514000837

  Same enrollment

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph Richard Deatherage, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Bismarck, ND
  • NPI 1003859117
  Authorized official Same address or phone
• Omar C Chahal, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Forks, ND
  • NPI 1639248719
  NPD
• Kelli J Gabel, CRNA

  • Certified Registered Nurse Anesthetist
  • Bismarck, ND
  • NPI 1205133873
  NPD
• Derek Miller, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Minneapolis, MN
  • NPI 1205366002
  NPD

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1104863505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 ELK DR",
            "address_2": "SUITE 3",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587011200",
            "telephone_number": "701-852-3421",
            "fax_number": "701-838-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 ELK DR",
            "address_2": "SUITE 3",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587011200",
            "telephone_number": "701-852-3421",
            "fax_number": "701-838-1842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACE AND JAW SURGEONS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "DEATHERAGE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DMD MD",
        "authorized_official_telephone_number": "701-258-7220",
        "authorized_official_credential": "DMD MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eyemart Express LLC (Eyemart Express)
• Eyes on Burdick Vision Therapy
• Faa Addiction Services
• Faa Addiction Services, LLC
• Nathan Peter Faa, LAC
• Kacey Fahey
• Christopher W Falcon, D.C.
• Emily Falcon, MD
• Michel Jean Farah, MD
• Fargo Vamc

• Oral and Maxillofacial Surgery (Dentist) in Minot, ND
• Providers in Minot, 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 Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.