Provider Demographics
NPI:1174932271
Name:HATTEN, ALESIA (DDS)
Entity type:Individual
Prefix:
First Name:ALESIA
Middle Name:
Last Name:HATTEN
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 1:24180 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3815
Mailing Address - Country:US
Mailing Address - Phone:601-212-5375
Mailing Address - Fax:601-212-5375
Practice Address - Street 1:6958 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-1618
Practice Address - Country:US
Practice Address - Phone:573-596-0411
Practice Address - Fax:573-596-0410
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9874122300000X
MO2014018760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist