DR. Donald Leon Theriault, DMD

NPI #1669502795 in Portland, Maine

Provider Information

NPI Number: 1669502795
Entity Type: Individual
Name: DR. Donald Leon Theriault, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - Periodontics
Credential: DMD
Enumeration Date: Mar 7, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 595 BRIGHTON AVE
City: Portland
State: Maine
ZIP Code: 04102-2322
Phone: (207) 774-1471

Specialties & Taxonomy Codes

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

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