Provider Demographics
NPI:1528682499
Name:NALBANDIAN, NICOLE G (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:G
Last Name:NALBANDIAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 DE SOTO AVE APT A222
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2628
Mailing Address - Country:US
Mailing Address - Phone:310-592-6348
Mailing Address - Fax:
Practice Address - Street 1:FIRST STREET DENTAL GROUP AND ORTHODONTICS
Practice Address - Street 2:1197 E LOS ANGELES AVE STE E
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-583-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice