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General NPI Number Information
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NPI Number | 1275916728
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Entity Type | Individual
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Provider Name | JACQUELINE DELASH DMD, MBA, MPH
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Gender | Female
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 1235 ROBINSON RD STE H
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3832
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Country | US
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Telephone | 770-487-1880
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Fax | 770-487-1851
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Provider Business Mailing Address
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Address Line | 1235 ROBINSON RD STE H
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3832
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Country | US
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Telephone | 770-487-1880
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Fax | 770-487-1851
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN014990
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN014990
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License Number State | GA
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