Individual
DR. DENISE M THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
276 CANCO RD, PORTLAND, ME 04103-4351
(207) 780-1822
(207) 780-6022
Mailing address
276 CANCO RD, PORTLAND, ME 04103-4351
(207) 780-1822
(207) 780-6022
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3390
ME
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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