Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8856 | TX |
N | 1223P0700X | Prosthodontist | 8856 | TX |
NPI | 1194257261 |
---|---|
Provider Name | Dr. James Mason Terry |
First Address | Houston, TX 77027 |
Second Address | Houston, TX 77027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 29/03/2017 |