Healthcare Provider Details

I. General information

NPI: 1811192180
Provider Name (Legal Business Name): MARCELO GABRIEL TOLEDO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326N RIVERSIDE AVE
RIALTO CA
92376-5926
US

IV. Provider business mailing address

326N RIVERSIDE AVE
RIALTO CA
92376-5926
US

V. Phone/Fax

Practice location:
  • Phone: 909-875-1464
  • Fax: 909-875-1467
Mailing address:
  • Phone: 909-875-1464
  • Fax: 909-875-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number54668
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number54668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: