Provider Demographics
NPI:1386696334
Name:JELINEK, MATTHEW G (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:JELINEK
Suffix:
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 1:4820 DUPONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5326
Mailing Address - Country:US
Mailing Address - Phone:612-281-8311
Mailing Address - Fax:
Practice Address - Street 1:3205 W 76TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5244
Practice Address - Country:US
Practice Address - Phone:952-841-0122
Practice Address - Fax:952-896-0010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice