MEDICARE: DENTAL FOUNDATIONS AND AESTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1104757129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL FOUNDATIONS AND AESTHETICS

Provider Business Mailing Address
First Line	:	20700 W THOMAS RD STE 101
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396-1697
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20700 W THOMAS RD STE 101
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396-1697
Country	:	US
Telephone Number	:	405-923-5535
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AUSTIN DANIEL LAU
Credential	:	DDS
Telephone Number	:	405-923-5535

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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