Individual provider · Type 1 NPI

Mary Vivianne Shannon, DDS

Pediatric Dentistry · Los Angeles, CA

NPI number 1760528525 Active

Practice location

11980 San Vicente Blvd Ste 906
Los Angeles, CA 90049-6607

Call (310) 998-8999 Map

Fax (310) 998-8999

Mailing address

357 S Glenroy Ave
Los Angeles, CA 90049-3136

Specialties and licenses

TaxonomyCodeLicense
Pediatric Dentistry Primary 1223P0221X48769 (CA)

Pediatric Dentistry: 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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About NPI 1760528525

Mary Vivianne Shannon, DDS's National Provider Identifier is 1760528525, issued on Jan 29, 2007. The primary taxonomy on file is Pediatric Dentistry (1223P0221X), and the practice location is in Los Angeles, CA. The record was last updated on Sep 26, 2012.