Provider Demographics
NPI:1891797130
Name:TAYLOR, TERRY D (DDS MS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:STE 614
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2727
Mailing Address - Country:US
Mailing Address - Phone:713-790-1995
Mailing Address - Fax:713-790-9562
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 614
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2727
Practice Address - Country:US
Practice Address - Phone:713-790-1995
Practice Address - Fax:713-790-9562
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2020-09-02
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TX13953204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135026604OtherCIDC ID
TX135026603Medicaid
TXD13953OtherBCBS ID
TXD13953OtherBCBS ID
TXT16222Medicare UPIN