# HIEM DENTAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wellness Dental Tatum/Shea
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194116475
- **Authorized official:** MR. DONGSUK KWAK (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (602) 899-0488

## Contact information

- **Practice address:** 10214 N TATUM BLVD, B600, PHOENIX, AZ 85028-4231
- **Practice address phone:** (602) 899-0488
- **Mailing address:** 10214 N TATUM BLVD, B600, PHOENIX, AZ 85028-4231
- **Mailing address phone:** (602) 899-0488
- **Mailing address fax:** (602) 884-8240

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | F000542 | AZ | Yes |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |

## Other

- **Enumeration date:** 02/09/2015
- **Last updated:** 11/14/2022