Healthcare Provider Details

I. General information

NPI: 1366448565
Provider Name (Legal Business Name): GAIL KAREN LEFSAKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 NEW YORK RANCH ROAD JACKSON RANCHERIA HEALTH COMPLEX
JACKSON CA
95642-9344
US

IV. Provider business mailing address

12150 NEW YORK RANCH ROAD JACKSON RANCHERIA HEALTH COMPLEX
JACKSON CA
95642-9344
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-2460
  • Fax: 209-257-2464
Mailing address:
  • Phone: 209-257-2460
  • Fax: 209-257-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: