Provider Demographics
NPI:1841283314
Name:TEDESCHI, NICHOLAS JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:TEDESCHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 MANTUA PIKE
Mailing Address - Street 2:SUITE 302 WESTWOOD ORAL SURGERY ASSOCIATES PA
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1246
Mailing Address - Country:US
Mailing Address - Phone:856-845-1341
Mailing Address - Fax:856-384-9067
Practice Address - Street 1:992 MANTUA PIKE
Practice Address - Street 2:SUITE 302 WESTWOOD ORAL SURGERY ASSOCIATES PA
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1246
Practice Address - Country:US
Practice Address - Phone:856-845-1341
Practice Address - Fax:856-384-9067
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1009193001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
17707OtherAETNA
NJ09193/1715OtherDELTA NJ
0085538000OtherAMERIHEALTH MANAGED CARE
160716ATLOtherPTAN
160716OtherAMERIHEALTH PPO
0160716Medicare ID - Type Unspecified
160716OtherAMERIHEALTH PPO