MEDICARE: MADELINE ROSE VARLAND DDS

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	122300000X	Dentist	D15067	MN
2	1223G0001X	General Practice Dentistry	D15067	MN

General Provider Information

NPI Number	:	1346081445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE ROSE VARLAND DDS

Provider Business Mailing Address
First Line	:	14466 COTTAGE GROVE DR
Second Line	:
City	:	BAXTER
State	:	MN
Zip	:	56425-8221
Country	:	US
Telephone Number	:	612-695-1196
Fax Number	:

Provider Business Practice Location Address
First Line	:	13367 ISLE DR STE 1
Second Line	:
City	:	BAXTER
State	:	MN
Zip	:	56425-2224
Country	:	US
Telephone Number	:	218-829-0795
Fax Number	:

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	01/31/2025

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