DR. DONALD LEON THERIAULT DMD
NPI 1669502795
Dentist - Periodontics in Portland, ME

Q: What is Donald Theriault's NPI number?

The NPI number for Donald Theriault is 1669502795. It was assigned to this individual provider in the NPPES registry on March 7, 2007.

Q: What is Donald Theriault's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Q: When was this NPI record last updated?

The NPPES record for Donald Theriault was last updated on July 8, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 07, 2007PECOS Enrolled

595 BRIGHTON AVE, PORTLAND, ME 04102(207) 774-1471 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Dr. Donald Leon Theriault Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DONALD LEON THERIAULT DMD (NPI 1669502795) is an individual periodontics provider in Portland, Maine, licensed in Maine (2974) and active in the NPI registry since March 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1669502795

Entity TypeIndividualMale

Primary Taxonomy1223P0300X

Provider Legal NameDR. DONALD LEON THERIAULTCredential: DMD

Location Address595 BRIGHTON AVEPortland, ME 04102-2322

Mailing Address595 Brighton AvePortland, ME 04102-2322 · (207) 774-1471

Phone(207) 774-1471

Sole ProprietorNo

Enumeration DateMarch 7, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1669502795 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers

Taxonomy Code1223P0300X

License✔ Licensed in ME · 2974

Definition

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.

595 BRIGHTON AVE, Portland, ME 04102

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Sheld, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Donald Leon Theriault Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 04102 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$86.72 typical visit price

range $56.28 – $169.96

Typical copayment $21.68 (range $14.07 – $42.49)

Most-billed visit code 99203

Established Patient

$70.13 typical visit price

range $18.22 – $138.92

Typical copayment $17.53 (range $4.55 – $34.73)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EYES ON ROSEMONT LLC

Optometrist (Vision Therapy)