Healthcare Provider Details

I. General information

NPI: 1609683028
Provider Name (Legal Business Name): KONNECT DENTAL KARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 SOUTHVIEW DR
KLAMATH FALLS OR
97603-8545
US

IV. Provider business mailing address

5017 SOUTHVIEW DR
KLAMATH FALLS OR
97603-8545
US

V. Phone/Fax

Practice location:
  • Phone: 503-679-7527
  • Fax:
Mailing address:
  • Phone: 503-679-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: BRENNA CHAVARIN
Title or Position: CEO
Credential: MSAH, EPDH
Phone: 503-679-7527