Provider Demographics
NPI:1720541709
Name:BOWEN, BRANDON M (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:M
Last Name:BOWEN
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 1:1356 S 2100 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2244
Mailing Address - Country:US
Mailing Address - Phone:801-913-0337
Mailing Address - Fax:801-581-0548
Practice Address - Street 1:1356 S 2100 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2244
Practice Address - Country:US
Practice Address - Phone:801-913-0337
Practice Address - Fax:801-581-0548
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT390200000X
UT11334328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program