Provider Demographics
NPI:1982593687
Name:MEYER, MADELYN (DDS)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CHINOOK AVE SW
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MN
Mailing Address - Zip Code:56310-9595
Mailing Address - Country:US
Mailing Address - Phone:320-248-4456
Mailing Address - Fax:
Practice Address - Street 1:900 GOLDEN SPIKE RD NE
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379
Practice Address - Country:US
Practice Address - Phone:320-252-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND153061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice