MATTHEW LIESEN

PEORIA, IL
NPI1619350725
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: IL  019030226)
Additional Taxonomies1223D0001X Dentist, Dental Public Health
(Licence: IL  019.030226)
Enumeration Date2015-07-07
Last Update Date2021-07-07
Business Address
Dr. MATTHEW LIESEN DMD
4517 N ROCKWOOD DR
PEORIA, IL 61615-3841
Phone number: 309-688-0121
Mailing Address
Dr. MATTHEW LIESEN DMD
4517 N ROCKWOOD DR
PEORIA, IL 61615-3841
Phone number: 309-688-0121