Provider Demographics
NPI:1407298227
Name:DELICA, J'NELLE (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:J'NELLE
Middle Name:
Last Name:DELICA
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 S STATE ROAD 7 STE 315
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8147
Mailing Address - Country:US
Mailing Address - Phone:561-892-2170
Mailing Address - Fax:
Practice Address - Street 1:3319 S STATE ROAD 7 STE 315
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8147
Practice Address - Country:US
Practice Address - Phone:561-892-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 202491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics