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FACE AND JAW SURGEONS PC NPI 1184667305


NPI Information

NPI: 1184667305
Provider Name: FACE AND JAW SURGEONS PC
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
1140 W CAPITOL AVE
BISMARCK, ND
ZIP 58501
Phone: (701) 258-7220
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FACE AND JAW SURGEONS PC is an oral and maxillofacial surgery dentist in Bismarck, ND. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. FACE AND JAW SURGEONS PC NPI is 1184667305. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1140 W CAPITOL AVE
BISMARCK, ND
ZIP 58501-956
Phone: (701) 258-7220
Fax: (701) 222-2329

The provider's authorized official is Joseph R Deatherage .
The authorized official title is Dmd Md and has the following contact phone number (701) 258-7220.

The enumeration date for this NPI number is 6/14/2006 and was last updated on 4/25/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
141124MEDICAIDNORTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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