Provider Demographics
NPI:1760485031
Name:MATELIS, JENNIFER BLUME (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BLUME
Last Name:MATELIS
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 1:3946 LEGATION ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2916
Mailing Address - Country:US
Mailing Address - Phone:202-680-0030
Mailing Address - Fax:
Practice Address - Street 1:22 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3582
Practice Address - Country:US
Practice Address - Phone:301-948-3111
Practice Address - Fax:301-948-8674
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice