CLAYTON ANTHONY LIESEN DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****03

License Status

ACTIVE

Business

Title

DMD

First Name

CLAYTON

Middle

ANTHONY

Last Name

LIESEN

Business Name

CLAYTON ANTHONY LIESEN DMD

Original Issue Date

05/12/2021

Effective Date

08/16/2024

Expiration Date

09/30/2027

City

QUINCY

State

Zip

62305

County

ADAMS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/16/2024