Individual
DR. MOLLY ROWE GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, PC
Contact information
Practice address
512 OLD CORVALLIS RD, HAMILTON, MT 59840-3131
(406) 363-1211
(406) 363-1212
Mailing address
512 OLD CORVALLIS RD, HAMILTON, MT 59840-3131
(406) 363-1211
(406) 363-1212
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2066
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20664
BLUE CROSS PROVIDER NUMBE
MT
05
—
5511948
—
MT
Enumeration date
11/01/2006
Last updated
10/25/2012
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