Individual
MOLLIE NORTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1310 OLD HIGHWAY 63 S, COLUMBIA, MO 65201-6078
(573) 449-0749
Mailing address
1310 OLD HIGHWAY 63 S, COLUMBIA, MO 65201-6078
(573) 449-0749
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2022019297
MO
Other
Enumeration date
06/01/2022
Last updated
06/01/2022
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