| Matthew Liesen, Dmd Pllc | |
|
3 Collinsport Dr Collinsville IL 62234-6104 | |
| (618) 344-6459 | |
| Not Available |
| Full Name | Matthew Liesen, Dmd Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3 Collinsport Dr, Collinsville, Illinois |
| Authorized Official Name and Position | Matthew J Liesen (OWNER/GENERAL DENTIST) |
| Authorized Official Contact | 2172484561 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Matthew Liesen, Dmd Pllc 3 Collinsport Dr Collinsville IL 62234-6104 Ph: (618) 344-6459 | Matthew Liesen, Dmd Pllc 3 Collinsport Dr Collinsville IL 62234-6104 Ph: (618) 344-6459 |
| NPI Number | 1134790454 |
|---|---|
| Provider Enumeration Date | 07/07/2021 |
| Last Update Date | 07/07/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134790454 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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