Healthcare Provider Details

I. General information

NPI: 1154251890
Provider Name (Legal Business Name): MADELYN ROSE SCHWIETERS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CHERRYWOOD ST NE
ISANTI MN
55040-2005
US

IV. Provider business mailing address

401 CHERRYWOOD ST NE
ISANTI MN
55040-2005
US

V. Phone/Fax

Practice location:
  • Phone: 763-444-5541
  • Fax:
Mailing address:
  • Phone: 763-444-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002178-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15540
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: