# DR PABLO ENRIQUE LICIAGA DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295801561
- **Authorized official:** DR. PABLO ENRIQUE LICIAGA DDS (DENTIST)
- **Authorized official phone:** (619) 224-2986

## Contact information

- **Practice address:** 2115 BACON ST, SAN DIEGO, CA 92107
- **Practice address phone:** (619) 224-2986
- **Practice address fax:** (619) 224-2982
- **Mailing address:** 2115 BACON ST, SAN DIEGO, CA 92107
- **Mailing address phone:** (619) 224-2986
- **Mailing address fax:** (619) 224-2982

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 49365 | CA | Yes |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 01/28/2015