Clayton Anthony Liesen, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1858010 Issued in MA

Practice address

188 Longwood Ave
Boston, MA 02115-5819

Phone

(617) 432-1434

NPI assigned

May 29, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1528559275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5137 BENZ RD",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623058213",
            "telephone_number": "217-242-7076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 LONGWOOD AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155819",
            "telephone_number": "617-432-1434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIESEN",
        "first_name": "CLAYTON",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-29",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1858010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Liebowitz, MD
• Norbert J Liebsch, MD PHD
• Alyssa Liebzeit
• Jessica Jayne Liegel, M.D.
• Cindy Lien, M.D.
• Meaghan Lieto, PA-C
• Sung Ja Lieu, M.D.
• Thien Lieu
• Mary L Lievens, NP
• Jean W Liew, MD

• General Practice Dentistry in Boston, MA
• Providers in Boston, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.