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MARY VIVIANNE SHANNON DDS
NPI 1760528525
Dentist - Pediatric Dentistry in Los Angeles, CA

Active since January 29, 2007
11980 SAN VICENTE BLVD STE 906, LOS ANGELES, CA 90049(310) 998-8999(310) 998-8999 Get Directions Write a Review

NPPES record last updated: September 26, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mary Vivianne Shannon Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY VIVIANNE SHANNON DDS (NPI 1760528525) is an individual pediatric dentistry provider in Los Angeles, California, licensed in California (48769) and active in the NPI registry since January 2007.

NPPES Registry Identity

NPI1760528525
Entity TypeIndividualFemale
Primary Taxonomy1223P0221X
Provider Legal NameMARY VIVIANNE SHANNONCredential: DDS
Location Address11980 SAN VICENTE BLVD STE 906Los Angeles, CA 90049-6607
Mailing Address357 S Glenroy AveLos Angeles, CA 90049-3136 · (310) 869-1332 · Fax (310) 471-3897
Phone(310) 998-8999
Fax(310) 998-8999
Sole ProprietorYes
Enumeration DateJanuary 29, 2007
Last NPPES UpdateSeptember 26, 2012
✔ NPI 1760528525 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in CA · 48769
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.
11980 SAN VICENTE BLVD STE 906, Los Angeles, CA 90049
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Other Identifiers 1

MedicaidD48769CA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas.Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

IRINE SIMS-KOMATSU DDS
Dentist (General Practice)
11980 SAN VICENTE BLVD STE 906
LOS ANGELES, CA 90049
Los Angeles County (310) 207-5900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Shannon's NPI number?

The NPI number for Mary Shannon is 1760528525. It was assigned to this individual provider in the NPPES registry on January 29, 2007.

Where is Mary Shannon located?

Mary Shannon practices at 11980 San Vicente Blvd Ste 906, Los Angeles, CA 90049. The listed phone number is (310) 998-8999.

What is Mary Shannon's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

What insurance does Mary Shannon accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Mary Shannon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mary Shannon was last updated on September 26, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.