Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Southern Maine Periodontal Assoc PA

Organization Periodontics · NPI 1295828069

Southern Maine Periodontal Assoc PA is a Periodontics in Portland, Maine. Licensed in Maine. Registered with an NPI since 2006.

Licensed in
ME
In the registry since
2006
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

276 Canco Rd
Portland, ME 04103
Phone: (207) 780-1822
Fax: (207) 780-6022
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Periodontics (primary) Taxonomy 1223P0300X · Licence 3390 (ME)

Record details

NPI number1295828069
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Denise Theriault — Owner · (207) 780-1922
Other names Denise M Theriault Dmd
NPI enumeratedOctober 2, 2006
Last updated in NPPESAugust 22, 2020
Mailing address276 Canco Rd, Portland, ME 04103

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