MEDICARE: KIMBERLY ANN ALBRECHT D.D.S.

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	1223G0001X	General Practice Dentistry	3360	AZ

General Provider Information

NPI Number	:	1740301514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN ALBRECHT D.D.S.

Provider Business Mailing Address
First Line	:	15640 N 7TH ST
Second Line	:	SUITE A-4
City	:	PHOENIX
State	:	AZ
Zip	:	85022-3512
Country	:	US
Telephone Number	:	602-843-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	15640 N 7TH ST
Second Line	:	SUITE A-4
City	:	PHOENIX
State	:	AZ
Zip	:	85022-3512
Country	:	US
Telephone Number	:	602-843-6000
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/02/2011

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