Individual
DR. NICHOLAS JAMES TEDESCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
992 MANTUA PIKE, SUITE 302 WESTWOOD ORAL SURGERY ASSOCIATES PA, WOODBURY HEIGHTS, NJ 08097-1246
(856) 845-1341
(856) 384-9067
Mailing address
992 MANTUA PIKE, SUITE 302 WESTWOOD ORAL SURGERY ASSOCIATES PA, WOODBURY HEIGHTS, NJ 08097-1246
(856) 845-1341
(856) 384-9067
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22D100919300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0085538000
AMERIHEALTH MANAGED CARE
—
01
—
09193/1715
DELTA NJ
NJ
01
—
160716
AMERIHEALTH PPO
—
01
—
160716ATL
PTAN
—
01
—
17707
AETNA
—
Enumeration date
08/30/2005
Last updated
01/25/2011
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