Individual
KIYA LEIGH STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4000 E CAMPUS LOOP S, LINCOLN, NE 68583-1530
(402) 472-1333
Mailing address
3835 BALDWIN AVE APT 68, LINCOLN, NE 68504-4107
(308) 430-2379
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7569
NE
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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