Healthcare Provider Details

I. General information

NPI: 1588596027
Provider Name (Legal Business Name): KIERSTEN STACK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13461 QUEBEC ST
THORNTON CO
80602-8647
US

IV. Provider business mailing address

13461 QUEBEC ST
THORNTON CO
80602-8647
US

V. Phone/Fax

Practice location:
  • Phone: 720-897-1452
  • Fax:
Mailing address:
  • Phone: 720-897-1452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206652
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: