Stephen T Liesen Dmd Llc | |
750 Mortimer St Barry IL 62312-1247 | |
(217) 335-2397 | |
(217) 335-2398 |
Full Name | Stephen T Liesen Dmd Llc |
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Speciality | Dentist |
Location | 750 Mortimer St, Barry, Illinois |
Authorized Official Name and Position | Stephen T Liesen (DENTIST/OWNER) |
Authorized Official Contact | 2173352397 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Stephen T Liesen Dmd Llc 750 Mortimer St Barry IL 62312-1247 Ph: (217) 335-2397 | Stephen T Liesen Dmd Llc 750 Mortimer St Barry IL 62312-1247 Ph: (217) 335-2397 |
NPI Number | 1174794028 |
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Provider Enumeration Date | 03/19/2008 |
Last Update Date | 10/22/2012 |
Identifier | Type | State | Issuer |
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1174794028 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 019021224 (Illinois) | Primary |