Basic Information
| Provider Information | |||||||||
| NPI: | 1225259971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEDESCO | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 MAIN ST | ||||||||
| Address2: | ATTN: JACKIE TAYLOR HIM | ||||||||
| City: | OLEAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147601513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163757536 | ||||||||
| FaxNumber: | 7163757521 | ||||||||
| Practice Location | |||||||||
| Address1: | 38 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DELEVAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140429501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167077042 | ||||||||
| FaxNumber: | 7167077055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 049461 | NY | Y | Dental Providers | Dentist |
No ID Information.