Provider Demographics
NPI:1366448565
Name:LEFSAKER, GAIL KAREN (RDH)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:KAREN
Last Name:LEFSAKER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 NEW YORK RANCH ROAD
Mailing Address - Street 2:JACKSON RANCHERIA HEALTH COMPLEX
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9344
Mailing Address - Country:US
Mailing Address - Phone:209-257-2460
Mailing Address - Fax:209-257-2464
Practice Address - Street 1:12150 NEW YORK RANCH ROAD
Practice Address - Street 2:JACKSON RANCHERIA HEALTH COMPLEX
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9344
Practice Address - Country:US
Practice Address - Phone:209-257-2460
Practice Address - Fax:209-257-2464
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA4378124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist