Provider Demographics
NPI:1083232813
Name:TOLEDO, MICHAEL JAMES RAVAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL JAMES
Middle Name:RAVAL
Last Name:TOLEDO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7749 WATERMARK LN S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4109
Mailing Address - Country:US
Mailing Address - Phone:904-363-1632
Mailing Address - Fax:
Practice Address - Street 1:7451 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9300
Practice Address - Country:US
Practice Address - Phone:904-777-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist