Search › Illinois › 1223G0001X
Matthew Liesen, DMD
NPI 1619350725 · on the registry since 2015
Practice
- Address
- 4517 N Rockwood Dr
Peoria, IL 61615 - Phone
- (309) 688-0121
- Fax
- (309) 688-5643
- Organisation at this address
- Peoria Dental Care
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 6
Registry record
- Primary taxonomy
- 1223G0001X
1223G0001X
- Also registered as
- 1223D0001X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2021-07-07
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois