Healthcare Provider Details

I. General information

NPI: 1679663132
Provider Name (Legal Business Name): ZANNA L CLIFFORD OLGUIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ZANNA CLIFFORD DDS

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MEADOW STREET #12
LYMAN WY
82937-8293
US

IV. Provider business mailing address

37 MEADOW ST # 12
LYMAN WY
82937-9008
US

V. Phone/Fax

Practice location:
  • Phone: 307-786-2300
  • Fax: 307-786-2345
Mailing address:
  • Phone: 307-786-2300
  • Fax: 307-786-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1064
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: