Provider Demographics
NPI:1225098304
Name:VARLAND, DAVID A (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:VARLAND
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 1:6068 PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8116
Mailing Address - Country:US
Mailing Address - Phone:815-877-3264
Mailing Address - Fax:815-877-3294
Practice Address - Street 1:6068 PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8116
Practice Address - Country:US
Practice Address - Phone:815-877-3264
Practice Address - Fax:815-877-3294
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0176911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000012079OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
IL6609390001Medicare NSC