MEDICARE: KONNECT DENTAL KARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant
2	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1609683028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KONNECT DENTAL KARE SERVICES

Provider Business Mailing Address
First Line	:	5017 SOUTHVIEW DR
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-8545
Country	:	US
Telephone Number	:	503-679-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	5017 SOUTHVIEW DR
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-8545
Country	:	US
Telephone Number	:	503-679-7527
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRENNA CHAVARIN
Credential	:	MSAH, EPDH
Telephone Number	:	503-679-7527

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	12/18/2024

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