Provider Demographics
NPI:1275916728
Name:DELASH, JACQUELINE (DMD, MBA, MPH)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:DELASH
Suffix:
Gender:F
Credentials:DMD, MBA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 ROBINSON RD STE H
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3832
Mailing Address - Country:US
Mailing Address - Phone:770-487-1880
Mailing Address - Fax:770-487-1851
Practice Address - Street 1:1235 ROBINSON RD STE H
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3832
Practice Address - Country:US
Practice Address - Phone:770-487-1880
Practice Address - Fax:770-487-1851
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0149901223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist