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General NPI Number Information
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NPI Number | 1174057319
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Entity Type | Organization
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Legal Business Name | BRIAN L. BECKSTROM P.C.
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 1091 N BLUFF ST SUITE 550
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City | ST GEORGE
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State | UT
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Zip | 84770-4894
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Country | US
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Telephone | 435-628-6200
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Fax | 435-652-9051
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Provider Business Mailing Address
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Address Line | 1091 N BLUFF ST SUITE 550
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City | ST GEORGE
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State | UT
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Zip | 84770-4894
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Country | US
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Telephone | 435-628-6200
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Fax | 435-652-9051
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Authorized Official
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Title or Position | PRESIDENT/ORTHODONTIST
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Name | DR. BRIAN BECKSTROM
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Credential | DDS, MSD
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Telephone | 435-628-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 93667439921
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License Number State | UT
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