NPIMap

Organization Active NPI

Shine Az LLC

  • Dental Clinic/Center
  • Glendale, AZ
National Provider Identifier
1689973679
Registry record updated Mar 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
7387 Issued in AZ
Legal business name
SHINE AZ LLC
Practice address
5940 W Union Hills Dr
B 190
Glendale, AZ 85308-1308
Phone
(602) 314-4600
Fax
(602) 314-5506
NPI assigned
Mar 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jonathan Bolesta, DMDNPI 1164616405
Title
Owner
Phone
(503) 877-8194

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 7387 AZ Primary

Addresses

Primary practice location

5940 W Union Hills Dr
B 190
Glendale, AZ 85308-1308

Mailing address

5940 W Union Hills Dr
B 190
Glendale, AZ 85308-1308
Phone (602) 314-4600

National Provider Directory

National Provider Directory

Locations

5940 W Union Hills Dr
Ste B190
Glendale, AZ 85308
Phone (602) 314-4600

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300233600000",
    "number": "1689973679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 W UNION HILLS DR",
            "address_2": "B 190",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081308",
            "telephone_number": "602-314-4600",
            "fax_number": "602-314-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5940 W UNION HILLS DR",
            "address_2": "B 190",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081308",
            "telephone_number": "602-314-4600",
            "fax_number": "602-314-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-16",
        "last_updated": "2011-03-16",
        "status": "A",
        "authorized_official_last_name": "BOLESTA",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-877-8194",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "7387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.