Southern Maine Periodontal Assoc PA

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

3390 Issued in ME

Legal business name

SOUTHERN MAINE PERIODONTAL ASSOC PA

Practice address

276 Canco Rd
Portland, ME 04103

Phone

(207) 780-1822

Fax

(207) 780-6022

NPI assigned

Oct 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Denise M Theriault, DMD

Title

Owner

Phone

(207) 780-1922

Specialties & licenses 1

Addresses

Other names 1

• Denise M Theriault DMD Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295828069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 CANCO RD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-780-1822",
            "fax_number": "207-780-6022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 CANCO RD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-780-1822",
            "fax_number": "207-780-6022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAINE PERIODONTAL ASSOC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THERIAULT",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-780-1922",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "ME",
            "license": "3390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Denise M Theriault DMD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Soundings Therapy Group, PLLC
• Jordan Kelly Sountis, AGACNP
• Sydney Marie Sousa, PA-C
• Sarah Chisholm Southard, A.N.P.
• Southern Maine Homecare, LLC
• Southern Maine Physical Medicine and Rehabilitation, PLLC
• Lauren Carol Spada
• Abigail Leah Spadone, LMSW-CC
• Molly K Spadone, LMSW-CC
• Lee R Spahr, PA

• Periodontics in Portland, ME
• Providers in Portland, ME by specialty
• Periodontics in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.