Provider Demographics
NPI:1790770592
Name:JOSE, MARIA LILIBETH LICAYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA LILIBETH
Middle Name:LICAYAN
Last Name:JOSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28877 BAILEY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-2168
Mailing Address - Country:US
Mailing Address - Phone:510-690-9896
Mailing Address - Fax:510-690-9899
Practice Address - Street 1:26953 MISSION BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4156
Practice Address - Country:US
Practice Address - Phone:510-690-9896
Practice Address - Fax:510-690-9899
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA404491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice