Provider Demographics
NPI:1356350292
Name:TREISTMAN, TERRY DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DAVID
Last Name:TREISTMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20660 WESTHEIMER PKWY
Mailing Address - Street 2:G
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5935
Mailing Address - Country:US
Mailing Address - Phone:281-599-7822
Mailing Address - Fax:281-599-8153
Practice Address - Street 1:23501 CINCO RANCH BLVD STE G225
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3418
Practice Address - Country:US
Practice Address - Phone:281-599-7822
Practice Address - Fax:281-599-8153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60189-04Medicaid