Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Southern Maine Periodontal Assoc PA

Organization Periodontics · NPI 1295828069

Southern Maine Periodontal Assoc PA provides 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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