Healthcare Provider Details

I. General information

NPI: 1205758893
Provider Name (Legal Business Name): GRACE ELIZABETH ALBERTSON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 E SHEA BLVD STE 150
PHOENIX AZ
85028-4256
US

IV. Provider business mailing address

3422 E BERYL LN
PHOENIX AZ
85028-3915
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-1448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: