Provider Demographics
NPI:1164159984
Name:BOWEN, MATTHEW KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KYLE
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N 850 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2154
Mailing Address - Country:US
Mailing Address - Phone:801-879-2199
Mailing Address - Fax:
Practice Address - Street 1:238 E STATE RD STE 2
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3621
Practice Address - Country:US
Practice Address - Phone:801-796-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12879656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist