Provider Demographics
NPI:1750954749
Name:TERRY, DR. DOUGLAS ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:DR. DOUGLAS
Middle Name:ALLEN
Last Name:TERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 BEAMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-3933
Mailing Address - Country:US
Mailing Address - Phone:281-481-3470
Mailing Address - Fax:281-484-0953
Practice Address - Street 1:12050 BEAMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-3933
Practice Address - Country:US
Practice Address - Phone:281-481-3470
Practice Address - Fax:281-484-0953
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730266255OtherNON MEDICARE OFFICE