Provider Demographics
NPI:1114795051
Name:HATEM, JESSICA ALEJANDRA (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ALEJANDRA
Last Name:HATEM
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20698 WOOD QUAY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8997
Mailing Address - Country:US
Mailing Address - Phone:914-525-1769
Mailing Address - Fax:
Practice Address - Street 1:2537 JOHN MILTON DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2527
Practice Address - Country:US
Practice Address - Phone:703-259-8477
Practice Address - Fax:703-662-9903
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist