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

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 MD

Title

DMD MD

Phone

(701) 258-7220

Specialties & licenses 1

Addresses

Other identifiers 1

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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• 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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41328",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.