Individual
MR. JAYSON J TERRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD, FACS, FAACS
Contact information
Practice address
805 TURTLE CREEK DR, TYLER, TX 75701-1937
(903) 592-1664
(903) 525-1099
Mailing address
805 TURTLE CREEK DR, TYLER, TX 75701-1937
(903) 592-1664
(903) 592-6595
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22097
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
M4965
TX
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
M4965
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195649203
—
TX
01
—
22097
TEXAS STATE DENTAL LICENSE
TX
01
—
751572652
GROUP ID
—
01
—
M4965
TEXAS MEDICAL LICENSE
TX
Enumeration date
11/29/2006
Last updated
02/23/2023
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