Active NPI
Benjamin Lively, DDS
- Dentist
- Portland, OR
National Provider Identifier
1891226569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D10603
- Practice address
- 2730 S Moody Ave
Portland, OR 97201-5042 - Phone
- (214) 726-6404
- NPI assigned
- Mar 24, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D10603 | OR | Primary |
Addresses
Primary practice location
2730 S Moody Ave
Portland, OR 97201-5042
Mailing address
2730 S Moody Ave
Portland, OR 97201-5042
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10603 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717459200000",
"number": "1891226569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2730 S MOODY AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972015042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2730 S MOODY AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972015042",
"telephone_number": "214-726-6404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIVELY",
"first_name": "BENJAMIN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-24",
"last_updated": "2024-06-04",
"certification_date": "2024-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.