Healthcare Provider Details

I. General information

NPI: 1740103621
Provider Name (Legal Business Name): ELIZABETH SHANNON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 CONCORD AVE
CHICO CA
95928-9518
US

IV. Provider business mailing address

14831 NORTHWOOD DR
MAGALIA CA
95954-9329
US

V. Phone/Fax

Practice location:
  • Phone: 530-809-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number23237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: