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General NPI Number Information
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NPI Number | 1164159984
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Entity Type | Individual
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Provider Name | MATTHEW KYLE BOWEN DDS
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Gender | Male
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 238 E STATE RD STE 2
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3621
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Country | US
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Telephone | 801-796-7779
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Fax |
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Provider Business Mailing Address
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Address Line | 51 N 850 E
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City | LINDON
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State | UT
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Zip | 84042-2154
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Country | US
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Telephone | 801-879-2199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12879656
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License Number State | UT
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