Provider Demographics
NPI:1790024438
Name:GALLANT, MICHELLE (RDH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GALLANT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CHICKAWAUKIE POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856
Mailing Address - Country:US
Mailing Address - Phone:207-593-9158
Mailing Address - Fax:
Practice Address - Street 1:37 CHICKAWAUKIE POND RD
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856
Practice Address - Country:US
Practice Address - Phone:207-593-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2347124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist