Individual
BENJAMIN LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2730 S MOODY AVE, PORTLAND, OR 97201-5042
(214) 726-6404
Mailing address
2730 S MOODY AVE, PORTLAND, OR 97201-5042
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10603
OR
Other
Enumeration date
03/24/2017
Last updated
06/04/2024
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