MATTHEW JOSEPH LIESEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****54

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

JOSEPH

Last Name

LIESEN

Business Name

MATTHEW JOSEPH LIESEN

Original Issue Date

06/25/2015

Effective Date

10/03/2018

Expiration Date

01/31/2022

City

PEORIA

State

Zip

61615

County

PIKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022