Organization
DUSTIN SHAUN TEDESCO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN TEDESCO MD (OWNER/PHYSICIAN)
(405) 936-0504
Entity
Organization
Contact information
Practice address
1553 N PORTER AVE, NORMAN, OK 73071-6621
(405) 217-8500
(405) 217-8501
Mailing address
1553 N PORTER AVE, NORMAN, OK 73071-6621
(405) 217-8500
(405) 217-8501
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
25729
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200206650B
—
OK
Enumeration date
05/05/2014
Last updated
05/05/2014
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