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1003256827
OCTAVIA S LIVELY
PORTLAND, OR
NPI
1003256827
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
122300000X Dentist
(Licence: OR D10027)
Enumeration Date
2013-06-25
Last Update Date
2019-02-12
Business Address
Dr. OCTAVIA S LIVELY DDS
3710 SW US VETRN HOSP RD
PORTLAND, OR 97239-2964
Phone number: 503-220-8262
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Mailing Address
Dr. OCTAVIA S LIVELY DDS
3710 SW US VETRN HOSP RD
PORTLAND, OR 97239-2964
Phone number: 503-220-8262
Copy
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