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General NPI Number Information
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NPI Number | 1821443672
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Entity Type | Organization
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Legal Business Name | H. CHARLES JELINEK JR. D.D.S.
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 8505 ARLINGTON BLVD. STE. 260
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 703-560-8700
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Fax | 703-560-1745
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Provider Business Mailing Address
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Address Line | 8505 ARLINGTON BLVD. STE. 260
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 703-560-8700
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Fax | 703-560-1745
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. ALLISON PLATT
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Credential |
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Telephone | 703-560-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 0401007079
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License Number State | VA
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