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General NPI Number Information
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NPI Number | 1184492027
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Entity Type | Organization
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Legal Business Name | WILDFLOWER KIDS DENTISTRY PLLC
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 3455 STONEMAN RD STE 2B
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City | DUBUQUE
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State | IA
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Zip | 52002-5269
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Country | US
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Telephone | 563-357-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 3455 STONEMAN RD STE 2B
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City | DUBUQUE
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State | IA
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Zip | 52002-5269
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Country | US
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Telephone | 563-582-1478
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Fax | 563-582-1479
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | LAUREN FANGMAN SCHAU
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Credential | DDS
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Telephone | 712-830-5824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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