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General NPI Number Information
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NPI Number | 1609683028
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Entity Type | Organization
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Legal Business Name | KONNECT DENTAL KARE SERVICES
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 5017 SOUTHVIEW DR
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-8545
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Country | US
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Telephone | 503-679-7527
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Fax |
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Provider Business Mailing Address
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Address Line | 5017 SOUTHVIEW DR
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-8545
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Country | US
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Telephone | 503-679-7527
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRENNA CHAVARIN
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Credential | MSAH, EPDH
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Telephone | 503-679-7527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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