Provider Demographics
NPI:1588757041
Name:CLIFFORD, LYNN J (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:J
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MEADOW ST
Mailing Address - Street 2:#11
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937
Mailing Address - Country:US
Mailing Address - Phone:307-786-2300
Mailing Address - Fax:307-786-2345
Practice Address - Street 1:37 MEADOW ST
Practice Address - Street 2:#11
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937
Practice Address - Country:US
Practice Address - Phone:307-786-2300
Practice Address - Fax:307-786-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist