Healthcare Provider Details

I. General information

NPI: 1275828840
Provider Name (Legal Business Name): SHANNIKA TRICIA DAO D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 BECHELLI LN
REDDING CA
96002
US

IV. Provider business mailing address

2695 BECHELLI LN
REDDING CA
96002-0926
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-4900
  • Fax:
Mailing address:
  • Phone: 530-222-4900
  • Fax: 530-842-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number056205
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: