| Doctor Name: | KATHLEEN MARIE STACK |
| NPI Number: | 1073793675 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RDH, MPH |
| License Number: | 007004 |
| Business Practice Address: | 1315 Main St Willimantic, CT - 062261948 |
| Business Phone Number: | 8604507456 |
| Business Fax Number: | 8604234629 |
| Mailing Address: | 84 High St, #3 MYSTIC |
| State: | CT |
| Postal Code: | 063552439 |
| Phone Number: | 8605140968 |
| Fax Number: | 8604234629 |
| NPI Enumeration Date: | 11/12/2007 |
| NPI Last Update Date: | 11/12/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 124Q00000X |
| License Number: | 007004 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dental Hygienist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |