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Mary Vivianne Shannon, DDS
Pediatric Dentist in Los Angeles, California
NPI 1760528525

Mary Vivianne Shannon is a Pediatric Dentist based in Los Angeles, CA and is specialized in Pediatric Dentistry. Mary Vivianne Shannon practices in Los Angeles, CA and has the professional credentials of DDS. The NPI Number for Mary Vivianne Shannon is 1760528525 and holds a License No. 48769 (California).

The current practice location address for Mary Vivianne Shannon is 11980 San Vicente Blvd Ste 906, Los Angeles, CA and can be reached out via phone at 310-998-8999 and via fax at 310-998-8999.

Location: 11980 San Vicente Blvd Ste 906, Los Angeles, CA, 90049-3136
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1760528525
Provider Name
Mary Vivianne Shannon
Credential
DDS
Provider Entity Type
Individual
Gender
Female
Address
11980 San Vicente Blvd Ste 906, Los Angeles, CA, 90049-3136
Phone Number
310-998-8999
Fax Number
310-998-8999
Provider Enumeration Date
01/29/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
D48769 05 CA
institution
Provider Business Practice Location Address Details
Address
11980 San Vicente Blvd Ste 906
City
Los Angeles
State
California
Zip
90049-6607
Phone Number
310-998-8999
Fax Number
310-998-8999
person
Provider Business Mailing Address Details
Address
11980 San Vicente Blvd Ste 906
City
Los Angeles
State
California
Zip
90049-6607
Phone Number
310-998-8999
Fax Number
310-998-8999
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
48769 (California)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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