Kathleen Marie Stack
Dental Hygienist
1315 Main St
Willimantic
, Connecticut 06226-1948
Kathleen Marie Stack
Dental Hygienist
1315 Main St
Willimantic
, Connecticut 06226-1948
(860) 423-4629
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About
Features
Specialties
- Dental Hygienist
Languages spoken
- English
Location
First Address
- Kathleen Marie Stack
- 84 High St #3
- Mystic, CT
- Zip : 06355-2439
- Fax : (860) 423-4629
- Phone : (860) 514-0968
Second Address
- Kathleen Marie Stack
- 1315 Main St
- Willimantic, CT
- Zip : 06226-1948
- Fax : (860) 423-4629
- Phone : (860) 450-7456
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | 007004 | CT |
National Provider Identifier
| NPI | 1073793675 |
|---|---|
| Provider Name | Kathleen Marie Stack |
| First Address | Mystic, CT 06355-2439 |
| Second Address | Willimantic, CT 06226-1948 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/11/2007 |
| Last Update Date | 12/11/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.