Healthcare Provider Details

I. General information

NPI: 1679407100
Provider Name (Legal Business Name): N ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 MAGNOLIA BLVD STE 209
VALLEY VILLAGE CA
91607-2348
US

IV. Provider business mailing address

11311 ISLETA ST
LOS ANGELES CA
90049-3022
US

V. Phone/Fax

Practice location:
  • Phone: 818-577-7850
  • Fax:
Mailing address:
  • Phone: 818-577-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NILOUFAR NOURI
Title or Position: ORTHODONTIST/OWNER
Credential: DDS
Phone: 818-577-7850