Organization
NICOLE MAHANIAN, D.D.S., INC.
Active
Other names
Tranquilo Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE MAHANIAN DDS (PRESIDENT)
(310) 853-2240
Entity
Organization
Contact information
Practice address
608 N MACLAY AVE, SAN FERNANDO, CA 91340-2137
(310) 486-4772
Mailing address
608 N MACLAY AVE, SAN FERNANDO, CA 91340-2137
(310) 853-2240
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104370972
NPI TYPE 1
CA
Enumeration date
08/30/2020
Last updated
08/30/2020
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