Provider Demographics
NPI:1821443672
Name:H. CHARLES JELINEK JR. D.D.S.
Entity Type:Organization
Organization Name:H. CHARLES JELINEK JR. D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-560-8700
Mailing Address - Street 1:8505 ARLINGTON BLVD.
Mailing Address - Street 2:STE. 260
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-560-8700
Mailing Address - Fax:703-560-1745
Practice Address - Street 1:8505 ARLINGTON BLVD.
Practice Address - Street 2:STE. 260
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-560-8700
Practice Address - Fax:703-560-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007079332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7394890001OtherMEDICARE PTAN