Individual
KATHLEEN MARIE STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, MPH
Contact information
Practice address
1315 MAIN ST, WILLIMANTIC, CT 06226-1948
(860) 450-7456
(860) 423-4629
Mailing address
84 HIGH ST, #3, MYSTIC, CT 06355-2439
(860) 514-0968
(860) 423-4629
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
007004
CT
Other
Enumeration date
11/12/2007
Last updated
11/12/2007
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