Mary 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:
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. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 13 May, 2024.