MEDICARE: DR. CRAIG PETER TOLNAY I DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30-022600	OH
2	1223G0001X	General Practice Dentistry	DS030385L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831188192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG PETER TOLNAY I DMD

Provider Business Mailing Address
First Line	:	415 N GRAND AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-3111
Country	:	US
Telephone Number	:	719-562-4461
Fax Number	:

Provider Business Practice Location Address
First Line	:	3353 MAHONING AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2617
Country	:	US
Telephone Number	:	330-792-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	08/11/2007

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