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FACE AND JAW SURGEONS PC
NPI 1104863505
Dentist - Oral and Maxillofacial Surgery in Minot, ND

Active since June 02, 2006CLIA 35D1058032 · Waiver
2615 ELK DR, SUITE 3, MINOT, ND 58701(701) 852-3421(701) 838-1842 Get Directions Write a Review

NPPES record last updated: June 8, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Face And Jaw Surgeons Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FACE AND JAW SURGEONS PC (NPI 1104863505) is a healthcare organization registered as an oral and maxillofacial surgery in Minot, North Dakota and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through August 27, 2026 and lists Joseph R Deatherage, Dmd Md, as its authorized official.

NPPES Registry Identity

NPI1104863505
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameFACE AND JAW SURGEONS PC
Location Address2615 ELK DR, SUITE 3Minot, ND 58701-1200
Mailing Address2615 Elk Dr, Suite 3Minot, ND 58701-1200 · (701) 852-3421 · Fax (701) 838-1842
Phone(701) 852-3421
Fax(701) 838-1842
Organization SubpartNo
Authorized OfficialJoseph R DeatherageDmd Md · (701) 258-7220
Enumeration DateJune 2, 2006
Last NPPES UpdateJune 8, 2017
✔ NPI 1104863505 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Definition
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.
2615 ELK DR, Minot, ND 58701
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Other Identifiers 2

Medicaid41328ND
Medicare PINN70243

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 35D1058032

Face And Jaw Surgery Center · Bismarck, ND
Active · expires Aug 27, 2026
CLIA Number35D1058032
Laboratory TypeOther
Certificate Effective DateAugust 28, 2024
Certificate Expiration DateAugust 27, 2026
Laboratory DirectorJoseph R. Deatherage
Laboratory Phone(701) 258-7220
Laboratory LocationFace And Jaw Surgery Center1730 Burnt Boat Dr Suite 300, Bismarck, ND 58503
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. BRYAN M VIBETO DDS
Dentist (Orthodontics and Dentofacial Orthopedics)
2615 ELK DR, STE 2
MINOT, ND 58701
Ward County (701) 839-6010
RAYANNE F SHANNON DDS
Dentist (Oral and Maxillofacial Surgery)
2615 ELK DR, STE 3
MINOT, ND 58701
Ward County (701) 852-3421
DR. STEPHANIE A RITTER DDS
Dentist (General Practice)
2615 ELK DR, SUITE 2
MINOT, ND 58701
Ward County (701) 837-1050
DR. KACI LYNN DRAPES D.M.D
Dentist (General Practice)
2615 ELK DR
MINOT, ND 58701
Ward County (701) 837-1050
DR. JEREMIAH J GLOSENGER D.D.S.
Dentist (Oral and Maxillofacial Surgery)
2615 ELK DR, SUITE 3
MINOT, ND 58701
Ward County (701) 852-3421

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Face And Jaw Surgeons PC's NPI number?

The NPI number for Face And Jaw Surgeons PC is 1104863505. It was assigned to this organization in the NPPES registry on June 2, 2006.

Where is Face And Jaw Surgeons PC located?

Face And Jaw Surgeons PC is located at 2615 Elk Dr Suite 3, Minot, ND 58701. The listed phone number is (701) 852-3421.

What is Face And Jaw Surgeons PC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Does Face And Jaw Surgeons PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 35D1058032) is associated with this NPI, valid through August 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Face And Jaw Surgeons PC was last updated on June 8, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.