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DR. GLEN A. TISTAERT DDS
NPI 1184841207
Dentist - General Practice in Santa Monica, CA

Active since April 19, 2007PECOS Enrolled
1333 7TH ST, SANTA MONICA, CA 90401(310) 394-2661(310) 450-9451 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Glen A. Tistaert Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GLEN A. TISTAERT DDS (NPI 1184841207) is an individual general practice provider in Santa Monica, California, licensed in California (18421) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1184841207
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. GLEN A. TISTAERTCredential: DDS
Location Address1333 7TH STSanta Monica, CA 90401-1607
Mailing Address2648 34th StSanta Monica, CA 90405-3115 · (310) 394-2661 · Fax (310) 451-8971
Phone(310) 394-2661
Fax(310) 450-9451
Sole ProprietorYes
Enumeration DateApril 19, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1184841207 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in CA · 18421
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
1333 7TH ST, Santa Monica, CA 90401
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Glen A. Tistaert Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Glen Tistaert's NPI number?

The NPI number for Glen Tistaert is 1184841207. It was assigned to this individual provider in the NPPES registry on April 19, 2007.

Where is Glen Tistaert located?

Glen Tistaert practices at 1333 7th St, Santa Monica, CA 90401. The listed phone number is (310) 394-2661.

What is Glen Tistaert's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Glen Tistaert enrolled in Medicare?

Yes. Glen Tistaert is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Glen Tistaert was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.