Healthcare Provider Details

I. General information

NPI: 1790951747
Provider Name (Legal Business Name): JOHN VICTOR TEDESCO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 S OXFORD AVE STE 200
TULSA OK
74137-7778
US

IV. Provider business mailing address

11911 S OXFORD AVE STE 200
TULSA OK
74137-7778
US

V. Phone/Fax

Practice location:
  • Phone: 918-984-5063
  • Fax: 918-600-0690
Mailing address:
  • Phone: 918-984-5063
  • Fax: 918-600-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number5170
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS10091
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: