Healthcare Provider Details

I. General information

NPI: 1235601659
Provider Name (Legal Business Name): BECKSTROM ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 S MALL DR STE 100
ST GEORGE UT
84790-5113
US

IV. Provider business mailing address

PO BOX 1288
WASHINGTON UT
84780-1288
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-3334
  • Fax: 435-652-9051
Mailing address:
  • Phone: 435-673-3334
  • Fax: 435-652-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRIAN L BECKSTROM
Title or Position: OWNER/ORTHODONTIST
Credential: DDS, MSD
Phone: 435-673-3334