Provider Demographics
NPI:1346081445
Name:VARLAND, MADELINE ROSE (DDS)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ROSE
Last Name:VARLAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14466 COTTAGE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8221
Mailing Address - Country:US
Mailing Address - Phone:612-695-1196
Mailing Address - Fax:
Practice Address - Street 1:13367 ISLE DR STE 1
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-2224
Practice Address - Country:US
Practice Address - Phone:218-829-0795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15067122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist