Provider Demographics
NPI:1811022981
Name:ETESSAM, NEDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:ETESSAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CHAIN BRIDGE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3882
Mailing Address - Country:US
Mailing Address - Phone:703-821-1633
Mailing Address - Fax:703-827-7750
Practice Address - Street 1:1401 CHAIN BRIDGE RD STE 301
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3882
Practice Address - Country:US
Practice Address - Phone:703-821-1633
Practice Address - Fax:703-827-7750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014100401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry