Provider Demographics
NPI:1003203498
Name:VARHOL, TYLER JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOHN
Last Name:VARHOL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 COUNTY ROAD D W STE 12
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3517
Mailing Address - Country:US
Mailing Address - Phone:612-788-9246
Mailing Address - Fax:
Practice Address - Street 1:550 COUNTY ROAD D W STE 12
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-3517
Practice Address - Country:US
Practice Address - Phone:127-889-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN135291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery