Provider Demographics
NPI:1730585670
Name:CHAVARIN, BRENNA RENAE (BS, EPDH)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:RENAE
Last Name:CHAVARIN
Suffix:
Gender:F
Credentials:BS, EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-8545
Mailing Address - Country:US
Mailing Address - Phone:503-679-7527
Mailing Address - Fax:
Practice Address - Street 1:5017 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-8545
Practice Address - Country:US
Practice Address - Phone:503-679-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6634124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist