Individual
DR. CLAYTON ANTHONY LIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
188 LONGWOOD AVE, BOSTON, MA 02115-5819
(617) 432-1434
Mailing address
5137 BENZ RD, QUINCY, IL 62305-8213
(217) 242-7076
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1858010
MA
Other
Enumeration date
05/29/2018
Last updated
10/12/2018
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