Individual
DUSTIN CURT LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
230 E JEFFERSON ST, MANGUM, OK 73554-4202
(580) 782-2552
(580) 782-9266
Mailing address
PO BOX 126, MANGUM, OK 73554-0126
(580) 782-2552
(580) 782-9266
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5327
OK
Other
Enumeration date
07/28/2006
Last updated
05/14/2019
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