Healthcare Provider Details

I. General information

NPI: 1174388722
Provider Name (Legal Business Name): LAURIE JAYNE TOLEDO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MYRTLE ST
NEW BRITAIN CT
06051-1859
US

IV. Provider business mailing address

PO BOX 120004
BOSTON MA
02112-0004
US

V. Phone/Fax

Practice location:
  • Phone: 860-321-1071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001078
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2.014912
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: