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General NPI Number Information
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NPI Number | 1083356661
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Entity Type | Individual
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Provider Name | MARIYA LELIKOVA DDS
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Gender | Female
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 15584 HESPERIAN BLVD
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City | SAN LORENZO
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State | CA
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Zip | 94580
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Country | US
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Telephone | 510-983-8924
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 KINGS HWY APT 2E
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City | BROOKLYN
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State | NY
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Zip | 11229
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Country | US
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Telephone |
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS110785
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 064182
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License Number State | NY
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