Individual
DR. DONALD LEON THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
595 BRIGHTON AVE, PORTLAND, ME 04102-2322
(207) 774-1471
Mailing address
595 BRIGHTON AVE, PORTLAND, ME 04102-2322
(207) 774-1471
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2974
ME
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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