Healthcare Provider Details

I. General information

NPI: 1194486134
Provider Name (Legal Business Name): BROOKE KEFFER EPDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ROBINSON

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
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: 541-281-9737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH8219
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: