Provider Demographics
NPI:1063415503
Name:TEDESCO, JAMES L (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:TEDESCO
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 1:1643 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4616
Mailing Address - Country:US
Mailing Address - Phone:716-675-3900
Mailing Address - Fax:716-675-2477
Practice Address - Street 1:1643 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4616
Practice Address - Country:US
Practice Address - Phone:716-675-3900
Practice Address - Fax:716-675-2477
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0328871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice