Provider Demographics
NPI:1740929462
Name:RIZZI, SHANNON MCCAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MCCAUL
Last Name:RIZZI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ELIZABETH
Other - Last Name:MCCAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8650 NE SHOAL CREEK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-8063
Mailing Address - Country:US
Mailing Address - Phone:816-429-5799
Mailing Address - Fax:
Practice Address - Street 1:8650 NE SHOAL CREEK VALLEY DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-8063
Practice Address - Country:US
Practice Address - Phone:816-429-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS618711223G0001X
MO2022032019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice