GLEN A. TISTAERT

SANTA MONICA, CA
NPI1184841207
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: CA  18421)
Enumeration Date2007-04-19
Last Update Date2007-07-08
Business Address
Dr. GLEN A. TISTAERT DDS
1333 7TH ST
SANTA MONICA, CA 90401-1607
Phone number: 310-394-2661
Mailing Address
Dr. GLEN A. TISTAERT DDS
2648 34TH ST
SANTA MONICA, CA 90405-3115
Phone number: 310-394-2661
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