Provider Demographics
NPI:1710163563
Name:VARIAN, KIMBERLY S (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:S
Last Name:VARIAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SUE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA
Mailing Address - Street 1:5122 PEPIN PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4723
Mailing Address - Country:US
Mailing Address - Phone:608-335-8134
Mailing Address - Fax:
Practice Address - Street 1:5122 PEPIN PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4723
Practice Address - Country:US
Practice Address - Phone:608-335-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10294-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist