National Provider Identifier Database

MATTHEW LIESEN, DMD – NPI #1619350725
General Practice

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.


Contact Information

MATTHEW LIESEN, DMD
4517 N ROCKWOOD DR
PEORIA, IL61615-3841
Phone: 309-688-0121
Fax: 309-688-5643
Website:
Specialty Taxonomy Code
* General Practice 1223G0001X
Dental Public Health 1223D0001X

* Indicates primary specialty

NPI Profile & details for MATTHEW LIESEN

NPI Number 1619350725
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 07/07/2015
Last updated 07/07/2021 - About 5 years ago
Sole proprietor1 No
Identifiers
  • IL License #: 019.030226
  • IL License #: 019030226
  • IL Other: 1851909345 PEORIA DENTAL CARE, LLC.
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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