Paul Michael Thorsen Buck, D.D.S., M.D.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

D13762 Issued in MN

Practice address

550 County Road D W Ste 12
New Brighton, MN 55112-3517

Phone

(612) 788-9246

NPI assigned

Apr 26, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 29, 2024 through Mar 29, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral & Maxillofacial Surgery Specialists, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Cambridge, MN
  • NPI 1508160060
  NPD (past)
• Oral & Maxillofacial Surgery Specialists, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Waconia, MN
  • NPI 1770694812
  NPD (past)
• Oral & Maxillofacial Surgery Specialists, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Maple Grove, MN
  • NPI 1902917057
  NPD (past)

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

{
    "created_epoch": "1335398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1992063093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 COUNTY ROAD D W STE 12",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551123517",
            "telephone_number": "612-788-9246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 COUNTY ROAD D W STE 12",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551123517",
            "telephone_number": "612-788-9246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCK",
        "first_name": "PAUL",
        "middle_name": "MICHAEL THORSEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-26",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OR",
            "license": "PG173069",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MN",
            "license": "D13762",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9768",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE60827554",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D9768",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lachelle Denise Brown
• Molly Brown
• Nanette Lousie Brown, MA, LP
• Eldon James Brue, PH.D., LP, LMFT
• Timothy Richard Brustad, L.A.D.C.
• Chesley Ann Buenger, LADC, LPCC
• Pamela Marie Bull, M.A, LPCC
• Scott Carl Burgi, MA
• Caroline A Burke, PH.D., LP
• Steven J Butorac

• Oral & Maxillofacial Surgery (D.M.D.) in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.