Healthcare Provider Details

I. General information

NPI: 1578205449
Provider Name (Legal Business Name): BRENNAN TOLNAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E POINTE DR STE 300
COLUMBIA MO
65201-6987
US

IV. Provider business mailing address

1522 ROSEWOOD TERRACE DR
BALLWIN MO
63021-8464
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-1525
  • Fax:
Mailing address:
  • Phone: 573-873-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2022019374
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: