Ethan Perry Livermont, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE61675458 Issued in WA

Practice address

150 W Sequim Bay Rd
Sequim, WA 98382-8406

Phone

(360) 565-5066

NPI assigned

May 28, 2025

Last updated

May 28, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Liver

  dba Eleven Eleven Dental

  • General Practice Dentistry
  • Port Angeles, WA
  • NPI 1619802758
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1972396208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 W SEQUIM BAY RD",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983828406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W SEQUIM BAY RD",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983828406",
            "telephone_number": "360-565-5066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVERMONT",
        "first_name": "ETHAN",
        "middle_name": "PERRY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-28",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61675458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lincare Inc.
• Rachel Diane Lindgren, PHARMD
• Shannon A Lindstrand, LMP
• Timothy A Lipski, MD
• Nicole Lynn Livengood, LMT
• John T Lloyd, PH.D.
• Lodge Chiropractic
• Donna Lodge, D.C.
• Valerie B Lodge, FNP
• David Lopez, PT, DPT

• Dentist in Sequim, WA
• Providers in Sequim, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.