Provider Demographics
NPI:1154992238
Name:WIESE, LAUREN N (DDS)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:N
Last Name:WIESE
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 1:1318 SW RADCLIFFE LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2169
Mailing Address - Country:US
Mailing Address - Phone:515-473-0945
Mailing Address - Fax:
Practice Address - Street 1:15 S WARRIOR LN
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9597
Practice Address - Country:US
Practice Address - Phone:515-987-8387
Practice Address - Fax:515-987-7718
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-099041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice