MEDICARE: MUSTAFA AL-GBURI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401420011	VA

General Provider Information

NPI Number	:	1851223168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUSTAFA AL-GBURI

Provider Business Mailing Address
First Line	:	723 SOUTHPARK BLVD STE F
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	723 SOUTHPARK BLVD STE F
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3628
Country	:	US
Telephone Number	:	804-504-0012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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