DR. Glen A. Tistaert, DDS
NPI #1184841207 in Santa Monica, California
Provider Information
- NPI Number
- 1184841207
- Entity Type
- Individual
- Name
- DR. Glen A. Tistaert, DDS
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Dentist - General Practice
- Credential
- DDS
- Enumeration Date
- Apr 19, 2007
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 1333 7TH ST
- City
- Santa Monica
- State
- California
- ZIP Code
- 90401-1607
- Phone
- (310) 394-2661
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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