Provider Demographics
NPI:1053330910
Name:THERIAULT, DAVID ARTHUR (DHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARTHUR
Last Name:THERIAULT
Suffix:
Gender:M
Credentials:DHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SUMMER STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841
Mailing Address - Country:US
Mailing Address - Phone:207-594-8353
Mailing Address - Fax:207-594-8306
Practice Address - Street 1:19 SUMMER STREET
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841
Practice Address - Country:US
Practice Address - Phone:207-594-8353
Practice Address - Fax:207-594-8306
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3298MAINE122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist