Healthcare Provider Details

I. General information

NPI: 1083356661
Provider Name (Legal Business Name): MARIYA LELIKOVA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16110 E 14TH ST
ASHLAND CA
94578-3002
US

IV. Provider business mailing address

16110 E 14TH ST
ASHLAND CA
94578-3002
US

V. Phone/Fax

Practice location:
  • Phone: 510-471-5880
  • Fax:
Mailing address:
  • Phone: 510-471-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS110785
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number064182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: