Peter John Debuck, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD2705 Issued in NM

Practice address

3501 N Butler Ave
Farmington, NM 87401-6429

Phone

(505) 918-1531

NPI assigned

Mar 17, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1013976232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 N BUTLER AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016429",
            "telephone_number": "505-918-1531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 N BUTLER AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016429",
            "telephone_number": "505-918-1531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBUCK",
        "first_name": "PETER",
        "middle_name": "JOHN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2022-03-10",
        "certification_date": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "332849",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD2705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93429266",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9180523",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michele Katherine De' Medici, RN;BSN;M,AC.;LIC.AC.
• Carlene R. Deal-Smith
• Regina Deale
• Victoria Dearly
• Spencer Terence Debauche
• Lawrence Andrew Decker, PAC
• Nicole K Deherrera, LISW
• Matthew Dekay, M.D.
• Villa Auleen Del Carmen, MD
• Samara Deleon, LMSW

• General Practice Dentistry in Farmington, NM
• Providers in Farmington, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.