Healthcare Provider Details

I. General information

NPI: 1417883745
Provider Name (Legal Business Name): UESSER HISHAM MOBDER AL-JANABY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

1001 E BYRD ST APT 6412
RICHMOND VA
23219-4295
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9190
  • Fax:
Mailing address:
  • Phone: 331-277-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0442000593
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: