Myles Iwen, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

1528844560 Issued in UT

Practice address

US Army Dentac Fort Cavazos
3600 Shoemaker Lane, Suite 1051
Fort Cavazos, TX 76544

Phone

(254) 287-2705

NPI assigned

Sep 6, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1528844560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "US ARMY DENTAC FORT CAVAZOS",
            "address_2": "3600 SHOEMAKER LANE, SUITE 1051",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-287-2705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US ARMY DENTAC FORT CAVAZOS",
            "address_2": "3600 SHOEMAKER LANE, SUITE 1051",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-287-2705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IWEN",
        "first_name": "MYLES",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-06",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "1528844560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel George Hutchings, LCSW
• Blanca Yasmin Ibarra Montanez
• Latoya Antonette Irwin, MSSW, LCSW
• Precious Peace Itugbu
• David S Iverson, MD
• Aaron Jackson, M.D.
• Cody Jackson, DO
• Danette M. Jackson, DO
• Mark Lawrence Jacques, M.D.
• Woohyuck Jang, DO

• Dentist in Fort Cavazos, TX
• Providers in Fort Cavazos, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.