Provider Demographics
NPI:1457905838
Name:PRESTON, TERRY LEON III
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEON
Last Name:PRESTON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 SAXON BEND TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4765
Mailing Address - Country:US
Mailing Address - Phone:139-227-6977
Mailing Address - Fax:
Practice Address - Street 1:1931 SAXON BEND TRL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4765
Practice Address - Country:US
Practice Address - Phone:139-227-6977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21005096172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver