{
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"FirstLineMailingAddress": "PO BOX 1288",
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"MailingAddressPostalCode": "84780-1288",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "435-673-3334",
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"FirstLinePracticeLocationAddress": "446 S MALL DR STE 100",
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"PracticeLocationAddressCityName": "ST GEORGE",
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"EnumerationDate": "12/24/2018",
"LastUpdateDate": "12/19/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BECKSTROM",
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"AuthorizedOfficialCredential": "DDS, MSD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}