Provider Demographics
NPI:1437377819
Name:LACKNER, KATHERINE LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LEE
Last Name:LACKNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:SEONKYUNG
Other - Last Name:LEE LACKNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9855 ERMA RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3001
Mailing Address - Country:US
Mailing Address - Phone:858-536-1500
Mailing Address - Fax:858-536-1574
Practice Address - Street 1:9855 ERMA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3001
Practice Address - Country:US
Practice Address - Phone:858-536-1500
Practice Address - Fax:858-536-1574
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice