Provider Demographics
NPI:1932228103
Name:MILES, BOWEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BOWEN
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 WEST 950 NORTH SUITE 102
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057
Mailing Address - Country:US
Mailing Address - Phone:801-434-5437
Mailing Address - Fax:801-225-7889
Practice Address - Street 1:1028 WEST 950 NORTH SUITE 102
Practice Address - Street 2:SUITE 100
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057
Practice Address - Country:US
Practice Address - Phone:801-434-5437
Practice Address - Fax:801-225-7889
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216151223X0400X
UT1371851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics