Provider Demographics
NPI:1275998676
Name:SHINE THIRTY-TWO INC.
Entity Type:Organization
Organization Name:SHINE THIRTY-TWO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-965-1800
Mailing Address - Street 1:110 SE GRANT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-3151
Mailing Address - Country:US
Mailing Address - Phone:515-965-1800
Mailing Address - Fax:888-278-0530
Practice Address - Street 1:110 SE GRANT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-3151
Practice Address - Country:US
Practice Address - Phone:515-965-1800
Practice Address - Fax:888-278-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty