# SHINE AZ LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689973679
- **Authorized official:** DR. JONATHAN BOLESTA DMD (OWNER)
- **Authorized official phone:** (503) 877-8194

## Contact information

- **Practice address:** 5940 W UNION HILLS DR, B 190, GLENDALE, AZ 85308-1308
- **Practice address phone:** (602) 314-4600
- **Practice address fax:** (602) 314-5506
- **Mailing address:** 5940 W UNION HILLS DR, B 190, GLENDALE, AZ 85308-1308
- **Mailing address phone:** (602) 314-4600
- **Mailing address fax:** (602) 314-5506

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 7387 | AZ | Yes |

## Other

- **Enumeration date:** 03/16/2011
- **Last updated:** 03/16/2011