SOUTHERN MAINE PERIODONTAL ASSOC PA (NPI# 1295828069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295828069 |
| Entity Type | Organization |
| Organization Name | SOUTHERN MAINE PERIODONTAL ASSOC PA |
| Other Organization Name | DENISE M THERIAULT DMD |
| Practice Address |
276 Canco Rd Portland ME 04103 |
| Practice Telephone | 2077801822 |
| Practice Fax Number | 2077806022 |
| Mailing Telephone | 2077801822 |
| Mailing Fax Number | 2077806022 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. DENISE M THERIAULT (OWNER) |
| Authorized Official Telephone | 2077801922 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
3390 | ME | Dental Providers |
| Other Name | Type Code |
|---|---|
| Denise M Theriault DMD | Former Legal Business Name - Organization |
| Street Address |
276 CANCO RD |
| City | PORTLAND |
| State | ME |
| Zip Code | 04103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174715197 | Jean M Pacewic | Dentist | 276 Canco Rd, Portland, ME 04103-4351 | 2007-08-14 |
| 1427254770 | Edward G Sebok | Dentist | 276 Canco Rd, Granite Heights, Portland, ME 04103 | 2007-06-25 |
| 1609098425 | Denise M Theriault | Dentist | 276 Canco Rd, Portland, ME 04103-4351 | 2007-05-02 |
| 1326169004 | James E Jackson | Dentist | 276 Canco Rd, Portland, ME 04103-4351 | 2007-04-02 |
| 1649305822 | Francesco Antonio Musciano | Dentist | 276 Canco Rd, Portland, ME 04103-4351 | 2007-02-21 |
| 1720128705 | Alan Joseph Hickey | Dentist | 276 Canco Rd, Portland, ME 04103-4351 | 2007-02-07 |
| 1518007509 | Alan David Newton | Dentist | 276 Canco Rd, Portland, ME 04103 | 2007-02-07 |
| 1487713905 | Lawrence Jacoby | Dentist | 276 Canco Rd, Portland, ME 04103-4351 | 2006-12-08 |
| 1104984970 | Michael Bennett | Dentist | 276 Canco Rd, Portland, ME 04103-4351 | 2006-12-05 |
| 1912065798 | Mary Berube Leblanc | Dentist | 276 Canco Rd, Portland, ME 04103-4351 | 2006-12-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790302677 | Hope for All Community Services LLC | Community/Behavioral Health | 68 Bishop St, Building 1, Unit 1, Portland, ME 04103 | 2020-06-26 |
| 1982251435 | Hope Home Healthcare, LLC | Home Health | 68 Bishop St Unit 3 #2, Portland, ME 04103 | 2019-08-20 |
| 1992367023 | Care for Everyone | In Home Supportive Care | 68 Bishop Street, Unit 1, Room 5, Portland, ME 04103 | 2019-06-28 |
| 1093373458 | Emanuel Nistrian | Student in an Organized Health Care Education/Training Program | Une, 716 Stevens Ave., Portland, ME 04103 | 2019-05-31 |
| 1023676483 | Robert Montague | Student in an Organized Health Care Education/Training Program | University of New England, 716 Stevens Ave, Portland, ME 04103 | 2019-05-31 |
| 1154838027 | Kimberly Therriault | Behavior Technician | 527 Ocean Ave Ste 19, Portland, ME 04103 | 2018-01-02 |
| 1285147918 | Teresa Maalouf | Community Health Worker | 23 Cambridge St., Portland, ME 04103 | 2017-11-16 |
| 1578082244 | Darcelle Kay Stillman | Occupational Therapist | 90 Dorothy St, Portland, ME 04103 | 2017-09-14 |
| 1821524943 | Engility Enterprises LLC | Case Management | 1 Coast Lane, Portland, ME 04103 | 2017-05-10 |
| 1720524283 | Hannah Rose Kazilionis | Counselor | 257 Deering Ave # 204, Portland, ME 04103 | 2017-01-09 |
| Find all providers in zip 04103 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871026062 | Leila Soltani | Dentist | 430 Sw 13th Ave Apt 2010, Portland, OR 97205 | 2017-04-05 |
| 1730632266 | Samar Shaikh | Dentist | 716 Stevens Ave # 204, Portland, ME 04103 | 2016-08-02 |
| 1730472986 | Wilson D Lee | Dentist | 315 Nw Lost Springs Ter, #401, Portland, OR 97229-6444 | 2011-05-20 |
| 1184954422 | Kamran Haghighat Bds Ms PC | Dentist | 833 Sw 11th Ave Ste 1020, Portland, OR 97205-2124 | 2010-01-08 |
| 1225292121 | Harjit Singh Sehgal | Dentist | 2730 Sw Moodey Ave, Clsb-5n034, Portland, OR 97201 | 2008-07-10 |
| 1467516211 | Chirgwin & Herriges, LLC | Dentist | 1130 Se 122nd Ave, Portland, OR 97233-1112 | 2006-12-19 |
| 1568534519 | Trang N Pham | Dentist | 10356 Ne Wasco St, Portland, OR 97220 | 2006-11-14 |
| 1811086887 | Winthrop B. Carter | Dentist | 611 Sw Campus Drive, Ohsu School of Dentistry, Sd 177, Portland, OR 97239 | 2006-10-11 |
| 1598702151 | Angela Blizzard | Dentist | 7107 Sw Macadam Ave, Portland, OR 97219-3075 | 2006-06-01 |
| 1104826817 | Scott L. Strong | Dentist | 1585 Sw Marlow Ave, Suite 216, Portland, OR 97225-5176 | 2005-07-22 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.