Organization
MATTHEW LIESEN, DMD PLLC
Active
Other names
Liesen Family Dental, Ronald Zambaldi, DMD
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J LIESEN DMD (OWNER/GENERAL DENTIST)
(217) 248-4561
Entity
Organization
Contact information
Practice address
3 COLLINSPORT DR, COLLINSVILLE, IL 62234-6104
(618) 344-6459
Mailing address
3 COLLINSPORT DR, COLLINSVILLE, IL 62234-6104
(618) 344-6459
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/07/2021
Last updated
07/07/2021
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