Provider Demographics
NPI:1184492027
Name:WILDFLOWER KIDS DENTISTRY PLLC
Entity type:Organization
Organization Name:WILDFLOWER KIDS DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:FANGMAN
Authorized Official - Last Name:SCHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-830-5824
Mailing Address - Street 1:3455 STONEMAN RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-5269
Mailing Address - Country:US
Mailing Address - Phone:563-582-1478
Mailing Address - Fax:563-582-1479
Practice Address - Street 1:3455 STONEMAN RD STE 2B
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5269
Practice Address - Country:US
Practice Address - Phone:563-357-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental