| Shine Az Llc | |
|
5940 W Union Hills Dr B 190 Glendale AZ 85308-1308 | |
| (602) 314-4600 | |
| (602) 314-5506 |
| Full Name | Shine Az Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5940 W Union Hills Dr, Glendale, Arizona |
| Authorized Official Name and Position | Jonathan Bolesta (OWNER) |
| Authorized Official Contact | 5038778194 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Az Llc 5940 W Union Hills Dr B 190 Glendale AZ 85308-1308 Ph: (602) 314-4600 | Shine Az Llc 5940 W Union Hills Dr B 190 Glendale AZ 85308-1308 Ph: (602) 314-4600 |
| NPI Number | 1689973679 |
|---|---|
| Provider Enumeration Date | 03/16/2011 |
| Last Update Date | 03/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689973679 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 7387 (Arizona) | Primary |
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