Individual
MRS. HEATHER STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
261 M 62, CASSOPOLIS, MI 49031-1034
(269) 228-8500
(269) 445-1928
Mailing address
21334 US HIGHWAY 12, EDWARDSBURG, MI 49112-9240
(269) 228-8500
(269) 445-1928
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902016335
MI
Other
Enumeration date
11/09/2015
Last updated
11/09/2015
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