Provider Demographics
NPI:1679663132
Name:CLIFFORD OLGUIN, ZANNA L (DDS)
Entity type:Individual
Prefix:DR
First Name:ZANNA
Middle Name:L
Last Name:CLIFFORD OLGUIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ZANNA
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:37 MEADOW ST # 12
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-9008
Mailing Address - Country:US
Mailing Address - Phone:307-786-2300
Mailing Address - Fax:307-786-2345
Practice Address - Street 1:37 MEADOW STREET #12
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937-8293
Practice Address - Country:US
Practice Address - Phone:307-786-2300
Practice Address - Fax:307-786-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice