Provider Demographics
NPI:1104970490
Name:JAMES W JELINEK DDS & SUSAN A YUNG DDS P C
Entity type:Organization
Organization Name:JAMES W JELINEK DDS & SUSAN A YUNG DDS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:JELINEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-349-0033
Mailing Address - Street 1:60 ROCK POINTE LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2630
Mailing Address - Country:US
Mailing Address - Phone:540-349-0033
Mailing Address - Fax:540-347-5872
Practice Address - Street 1:60 ROCK POINTE LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2630
Practice Address - Country:US
Practice Address - Phone:540-349-0033
Practice Address - Fax:540-347-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6688122300000X
VA6730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA234018OtherANTHEM PROVIDER
VA234019OtherANTHEM PROVIDER
VA817559OtherUCCI PROVIDER
VA00606001OtherDELTA DENTAL PROVIDER