=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235601659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BECKSTROM ORTHODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2018
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 446 S MALL DR STE 100
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84790-5113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-673-3334
-----------------------------------------------------
Fax | 435-652-9051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1288
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84780-1288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-673-3334
-----------------------------------------------------
Fax | 435-652-9051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ORTHODONTIST
-----------------------------------------------------
Name | BRIAN L BECKSTROM
-----------------------------------------------------
Credential | DDS, MSD
-----------------------------------------------------
Telephone | 435-673-3334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------