Individual
DR. OCTAVIA S LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3710 SW US VETRN HOSP RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
3710 SW US VETRN HOSP RD, PORTLAND, OR 97239-2964
(503) 220-8262
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10027
OR
Other
Enumeration date
06/25/2013
Last updated
02/12/2019
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