MEDICARE: DR. MICHAEL SPENSER BOWEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12304444-9922	UT

General Provider Information

NPI Number	:	1508430414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SPENSER BOWEN DDS

Provider Business Mailing Address
First Line	:	1275 E FORT UNION BLVD STE 200
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-1885
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 E FORT UNION BLVD STE 200
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-1885
Country	:	US
Telephone Number	:	801-676-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2021
Last Update Date	:	05/15/2021

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