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Organization

SOUTHERN MAINE PERIODONTAL ASSOC PA

Active
Other names
Denise M Theriault DMD
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DENISE M THERIAULT DMD (OWNER)
(207) 780-1922
Entity
Organization

Contact information

Practice address
276 CANCO RD, PORTLAND, ME 04103
(207) 780-1822
(207) 780-6022
Mailing address
276 CANCO RD, PORTLAND, ME 04103
(207) 780-1822
(207) 780-6022

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3390
ME

Other

Enumeration date
10/02/2006
Last updated
08/22/2020
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