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General NPI Number Information
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NPI Number | 1386696334
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Entity Type | Individual
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Provider Name | MATTHEW G. JELINEK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3205 W 76TH ST SUITE 1
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City | EDINA
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State | MN
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Zip | 55435-5244
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Country | US
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Telephone | 952-841-0122
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Fax | 952-896-0010
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Provider Business Mailing Address
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Address Line | 4820 DUPONT AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-5326
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Country | US
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Telephone | 612-281-8311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D10982
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License Number State | MN
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