Healthcare Provider Details

I. General information

NPI: 1982517215
Provider Name (Legal Business Name): SHANNON MARIE FOSTER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON TUCKER RDH

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 PEPPER ST
SUTTER CA
95982-2269
US

IV. Provider business mailing address

2511 PEPPER ST
SUTTER CA
95982-2269
US

V. Phone/Fax

Practice location:
  • Phone: 530-682-3720
  • Fax:
Mailing address:
  • Phone: 530-682-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number24779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: