Provider Demographics
NPI:1750629333
Name:CLIFFORD OLGUIN DENTAL CARE
Entity Type:Organization
Organization Name:CLIFFORD OLGUIN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTSIT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLIFFORD-OLGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-786-2300
Mailing Address - Street 1:37 MEADOW ST # 11
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 ST # 11
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937-9008
Practice Address - Country:US
Practice Address - Phone:307-786-2300
Practice Address - Fax:307-786-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty