Provider Demographics
NPI:1518170539
Name:TOLEDO, GERARDO ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:ALBERTO
Last Name:TOLEDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7120
Mailing Address - Country:US
Mailing Address - Phone:909-658-5225
Mailing Address - Fax:
Practice Address - Street 1:1233 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4402
Practice Address - Country:US
Practice Address - Phone:909-658-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56766OtherCALIFORNIA DENTAL LICENSE