Deatherage, Joseph Richard
Deatherage, Joseph Richard is an individual health care provider with primary practice located at 1730 Burnt Boat Dr Ste 300 , Bismarck ND 58503-0886. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Deatherage, Joseph Richard can be contacted via phone (701) 258-7220.Contact Information
Primary practice address
1730 Burnt Boat Dr Ste 300
Bismarck ND 58503-0886
Phone: (701) 258-7220
Fax: (701) 222-2329
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 2069 | North Dakota |
Profile Details
| NPI number | 1003859117 |
|---|---|
| LBN Legal business name | Deatherage, Joseph Richard |
| Credentials | DMD, MD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 14th, 2006 |
| Last updated | May 1st, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003859117 | NPPES |
| North Dakota | Other | 2069 | DENTAL LICENSE |
| North Dakota | MEDICAID | 41524 | DENTAL LICENSE |
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