MEDICARE: DR. J'NELLE DELICA DMD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	DN 20249	FL

General Provider Information

NPI Number	:	1407298227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J'NELLE DELICA DMD, MPH

Provider Business Mailing Address
First Line	:	3319 S STATE ROAD 7 STE 315
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8147
Country	:	US
Telephone Number	:	561-892-2170
Fax Number	:

Provider Business Practice Location Address
First Line	:	3319 S STATE ROAD 7 STE 315
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8147
Country	:	US
Telephone Number	:	561-892-2170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	06/11/2019

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