Individual
AGNES C TISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1112 N VIRGIL AVENUE, LOS ANGELES, CA 90029-2016
(323) 665-1208
(323) 665-1203
Mailing address
1112 N VIRGIL AVENUE, LOS ANGELES, CA 90029-2016
(323) 665-1208
(323) 665-1203
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
42529
CA
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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