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General NPI Number Information
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NPI Number | 1669331740
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Entity Type | Organization
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Legal Business Name | MLM SKIN AND HAIR RESTORATION CLINIC LLC
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 101 E FOREST AVE
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City | COLUMBIA
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State | MO
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Zip | 65203-4067
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Country | US
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Telephone | 573-489-1059
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E FOREST AVE
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City | COLUMBIA
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State | MO
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Zip | 65203-4067
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Country | US
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Telephone | 573-489-1059
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Fax |
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Authorized Official
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Title or Position | TRICHOLOGIST
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Name | MARY MOSS
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Credential |
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Telephone | 573-489-1059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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