Molly Rowe Gannon, DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2066 Issued in MT

Practice address

512 Old Corvallis Rd
Hamilton, MT 59840-3131

Phone

(406) 363-1211

Fax

(406) 363-1212

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Molly R Gannon Professional name

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Molly R Gannon D D S P C

  • General Practice Dentistry
  • Hamilton, MT
  • NPI 1639416738
  NPD (past) Authorized official

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351123200000",
    "number": "1083791784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 OLD CORVALLIS RD",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "598403131",
            "telephone_number": "406-363-1211",
            "fax_number": "406-363-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 OLD CORVALLIS RD",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "598403131",
            "telephone_number": "406-363-1211",
            "fax_number": "406-363-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "MOLLY",
        "middle_name": "ROWE",
        "name_prefix": "Dr.",
        "credential": "DDS, PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "2066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "20664",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5511948",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MOLLY",
            "last_name": "GANNON",
            "middle_name": "R",
            "credential": "D D S P C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• General Practice Dentistry in Hamilton, MT
• Providers in Hamilton, MT by specialty
• General Practice Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.