Individual
PETER JOHN DEBUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3501 N BUTLER AVE, FARMINGTON, NM 87401-6429
(505) 918-1531
Mailing address
3501 N BUTLER AVE, FARMINGTON, NM 87401-6429
(505) 918-1531
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
332849
UT
1223G0001X
General Practice Dentistry
Primary
DD2705
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9180523
—
NM
05
—
93429266
—
NM
Enumeration date
03/17/2006
Last updated
03/10/2022
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