Southern Maine Periodontal Assoc PA

NPI #1295828069 in Portland, Maine

Provider Information

NPI Number: 1295828069
Entity Type: Organization
Organization Name: Southern Maine Periodontal Assoc PA
Primary Specialty: Dentist - Periodontics
Enumeration Date: Oct 2, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 276 CANCO RD
City: Portland
State: Maine
ZIP Code: 04103
Phone: (207) 780-1822

Authorized Official

Name: DR. DENISE M THERIAULT, DMD
Title: OWNER
Phone: (207) 780-1922

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Periodontics — Periodontics	1223P0300X	Primary

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