STEPHEN T LIESEN Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****43

License Status

ACTIVE

Business

First Name

STEPHEN T

Last Name

LIESEN

Business Name

STEPHEN T LIESEN

Original Issue Date

08/29/1988

Effective Date

05/08/2024

Expiration Date

09/30/2027

City

BARRY

State

Zip

62312

County

PIKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/08/2024