| NPI | 1104970490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES W JELINEK Owner 540-349-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 6730) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 6688) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-08-06 |