Mary Vivianne Shannon
DDS | Pediatric Dentist
11980 San Vicente Blvd Ste 906, Los Angeles
California, 90049-6607
310-998-8999 310-998-8999
Maps & DirectionsMary Vivianne Shannon is a Los Angeles, California based Pediatric Dentist who is specialized in
Pediatric Dentistry. She does not accept the Medicare-approved amount. Patients will be billed for the treatment. Active license number of Mary Vivianne Shannon is
48769 for Pediatric Dentistry in California. Her current practice location is
11980 San Vicente Blvd Ste 906, Los Angeles. Patients can reach her at
310-998-8999.
Mary Vivianne Shannon provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Complete Profile:
Mary Vivianne Shannon speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
| Name: | Mary Vivianne Shannon |
| Specialization: | Pediatric Dentist |
| Gender: | Female |
| Credentials: | DDS |
| Accepts Medicare Assignment: | No |
| Practice Address: | 11980 San Vicente Blvd Ste 906, Los Angeles,
California, 90049-6607 |
| Phone: | 310-998-8999 |
| Fax: | 310-998-8999 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| NPI Number: | 1760528525 |
| NPI Enumeration Date: | 29 Jan, 2007 |
| NPI Last Update On: | 26 Sep, 2012 |
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mary Vivianne Shannon are as mentioned below.
| License Number | Specialization | State | Status | |
| 48769 | Pediatric Dentistry | California | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers associated with Mary Vivianne Shannon such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| D48769 | Medicaid | California | |
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 357 S Glenroy Ave,
Los Angeles, California |
| Zip: | 90049-3136 |
| Phone Number: | 310-869-1332 |
| Fax Number: | 310-471-3897 |
Patients can reach Mary Vivianne Shannon at
11980 San Vicente Blvd Ste 906, Los Angeles, California or can
call to book an appointment on 310-998-8999.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.