MEDICARE: NOURIAN DENTAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1174309934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURIAN DENTAL INC.

Provider Business Mailing Address
First Line	:	8424 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3610
Country	:	US
Telephone Number	:	818-510-3440
Fax Number	:

Provider Business Practice Location Address
First Line	:	8424 VAN NUYS BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3610
Country	:	US
Telephone Number	:	818-510-3440
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. NATHAN NOURIAN
Credential	:	DDS
Telephone Number	:	818-510-3440

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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