NPI 1003256827

Octavia S Lively, DDS

Practitioner Dentist Portland, OR

Practice location

Address: 3710 SW US Vetrn Hosp Rd, Portland, OR 97239-2964
Phone: (503) 220-8262

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence D10027 (OR)

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Registry record

NPI: 1003256827
Entity type: Individual
Sex (as registered): Female
NPI issued: 25 Jun 2013
Record last updated: 12 Feb 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.