Andrew Tedesco, DDS – Dentist in Delevan, NY

Key facts

NPI: 1225259971
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: 049461 (NY)
Practice address: 38 N Main St
Delevan, NY 14042-9501
Phone: (716) 707-7042
Fax: (716) 707-7055
NPI assigned: May 1, 2007
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NY
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20170919003356	NY	Order and Referring Only - Dentist Practitioner - Dentist	1456625169

National Provider Directory

Medicare enrollment (NPD): Yes

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	049461	NY	Yes

Addresses

Primary practice location

38 N Main St
Delevan, NY 14042-9501

Mailing address

515 Main St
Attn: Jackie Taylor Him
Olean, NY 14760-1513
Phone (716) 375-7536

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1225259971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 MAIN ST",
            "address_2": "ATTN: JACKIE TAYLOR HIM",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147601513",
            "telephone_number": "716-375-7536",
            "fax_number": "716-375-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 N MAIN ST",
            "city": "DELEVAN",
            "state": "NY",
            "postal_code": "140429501",
            "telephone_number": "716-707-7042",
            "fax_number": "716-707-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDESCO",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "049461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delevan, NY

All providers in Delevan, NY · Dentist in New York

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.