Provider Demographics
NPI:1467591743
Name:FEIST, TRICIA SUZANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:SUZANNE
Last Name:FEIST
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4743
Mailing Address - Country:US
Mailing Address - Phone:310-453-8606
Mailing Address - Fax:310-453-7055
Practice Address - Street 1:2730 WILSHIRE BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4743
Practice Address - Country:US
Practice Address - Phone:310-453-8606
Practice Address - Fax:310-453-7055
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist