Most Relevant Information
Provider Data
| NPI Number: | 1003256827 |
| Provider Name: | OCTAVIA S LIVELY DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | D10027 |
Most Important Dates
| Enumeration Date: | 06/25/2013 |
| Last Updated: | 02/12/2019 |
Provider Practice Location
3710 SW US VETRN HOSP RD
PORTLAND
OR
972392964
Practice Location Phone/Fax
| Phone: | 5032208262 |
| Fax: |
Provider Mailing Location
3710 SW US VETRN HOSP RD
PORTLAND
OR
972392964
Provider Mailing Phone/Fax
| Phone: | 5032208262 |
| Fax: |