Provider Demographics
NPI:1962627554
Name:JELINEK, H CHARLES JR (DDS)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:CHARLES
Last Name:JELINEK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 ARLINGTON BLVD
Mailing Address - Street 2:STE. 260
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4621
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:22031-4621
Practice Address - Country:US
Practice Address - Phone:703-560-8700
Practice Address - Fax:703-560-1745
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA70791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7394890001OtherPTAN
VAVA7079OtherVIGINIA LICENSE
VA7394890001OtherPTAN