MATTHEW JOSEPH LIESEN Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****11

License Status

ACTIVE

Business

First Name

MATTHEW

Middle

JOSEPH

Last Name

LIESEN

Business Name

MATTHEW JOSEPH LIESEN

Original Issue Date

11/05/2021

Effective Date

05/16/2024

Expiration Date

09/30/2027

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/16/2024