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General NPI Number Information
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NPI Number | 1619802758
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Entity Type | Organization
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Legal Business Name | LIVER
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Dates
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Enumeration Date | 06/17/2026
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Last Update Date | 06/17/2026
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Provider Practice Location Address
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Address Line | 1111 COLUMBIA ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-4207
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Country | US
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Telephone | 360-565-5066
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Fax |
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Provider Business Mailing Address
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Address Line | 150 W SEQUIM BAY RD
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City | SEQUIM
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State | WA
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Zip | 98382-8406
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Country | US
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Telephone | 360-565-5066
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | ETHAN LIVERMONT
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Credential | DDS
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Telephone | 360-565-5066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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