Provider Demographics
NPI:1538054655
Name:MANOUKIAN, NELLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:NELLIE
Middle Name:
Last Name:MANOUKIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 POPPYSEED LN APT I
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2942
Mailing Address - Country:US
Mailing Address - Phone:818-632-6667
Mailing Address - Fax:
Practice Address - Street 1:140 N A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5315
Practice Address - Country:US
Practice Address - Phone:805-483-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist