| NPI | 1730897026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DEATHERAGE Surgeon, Owner 701-258-7220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2022-11-07 |