Provider Demographics
NPI:1093897043
Name:REYNOLDS, TERRILYN JAMILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRILYN
Middle Name:JAMILLE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 HIGHWAY 6 S STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-4207
Mailing Address - Country:US
Mailing Address - Phone:281-759-5900
Mailing Address - Fax:281-759-5900
Practice Address - Street 1:3402 HIGHWAY 6 S STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4207
Practice Address - Country:US
Practice Address - Phone:281-759-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0117151223G0001X
TX30760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00932709AMedicaid