Provider Demographics
NPI:1932628542
Name:SHINE DENTAL ARTS PLLC
Entity Type:Organization
Organization Name:SHINE DENTAL ARTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:FR
Authorized Official - Last Name:QUIHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-893-3072
Mailing Address - Street 1:4950 E ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4306
Mailing Address - Country:US
Mailing Address - Phone:480-893-3072
Mailing Address - Fax:
Practice Address - Street 1:4950 E ELLIOT RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4306
Practice Address - Country:US
Practice Address - Phone:480-893-3072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD85551223G0001X
AZD85541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty