Provider Demographics
NPI:1659448108
Name:TERRES, JAYSON J (DDS, MD, FACS, FAACS)
Entity Type:Individual
Prefix:MR
First Name:JAYSON
Middle Name:J
Last Name:TERRES
Suffix:
Gender:M
Credentials:DDS, MD, FACS, FAACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1937
Mailing Address - Country:US
Mailing Address - Phone:903-592-1664
Mailing Address - Fax:903-592-6595
Practice Address - Street 1:805 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1937
Practice Address - Country:US
Practice Address - Phone:903-592-1664
Practice Address - Fax:903-525-1099
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220971223S0112X
TXM4965204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22097OtherTEXAS STATE DENTAL LICENSE
751572652OtherGROUP ID
TXM4965OtherTEXAS MEDICAL LICENSE
TX195649203Medicaid