Individual
DR. LAWRENCE JOHN LIESEN I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6N182 SUNSET DR., ST. CHARLES, IL 60175
(630) 443-0480
Mailing address
6N182 SUNSET DR., ST. CHARLES, IL 60175
(630) 443-0480
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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