Provider Demographics
NPI:1578092854
Name:CHRIS, SHANNON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:CHRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7936 CAVALIER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95832-9728
Mailing Address - Country:US
Mailing Address - Phone:209-596-5113
Mailing Address - Fax:
Practice Address - Street 1:1736 PICASSO AVE STE D
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-0548
Practice Address - Country:US
Practice Address - Phone:530-756-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1013981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice