Shannon, Mary Vivianne
Shannon, Mary Vivianne is an sole proprietor health care provider with primary practice located at 11980 San Vicente Blvd Ste 906 , Los Angeles CA 90049-6607. She recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as her primary health care specialty. Shannon, Mary Vivianne can be contacted via phone (310) 998-8999.Contact Information
Primary practice address
11980 San Vicente Blvd Ste 906
Los Angeles CA 90049-6607
Phone: (310) 998-8999
Fax: (310) 998-8999
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | 48769 | California |
Profile Details
| NPI number | 1760528525 |
|---|---|
| LBN Legal business name | Shannon, Mary Vivianne |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 29th, 2007 |
| Last updated | Sep 26th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760528525 | NPPES |
| California | MEDICAID | D48769 |
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