Provider Demographics
NPI:1710319744
Name:SCHAEFER, LULU FANG (DDS)
Entity type:Individual
Prefix:DR
First Name:LULU
Middle Name:FANG
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LULU
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:788 OAKLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2265
Mailing Address - Country:US
Mailing Address - Phone:714-834-8414
Mailing Address - Fax:
Practice Address - Street 1:788 OAKLEAF WAY
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2265
Practice Address - Country:US
Practice Address - Phone:714-834-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002540-151223E0200X
TX292111223G0001X
IARES-30544390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice