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General NPI Number Information
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NPI Number | 1396035416
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Entity Type | Individual
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Provider Name | BRIAN BECKSTROM
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Gender | Male
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Dates
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Enumeration Date | 04/10/2011
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 1091 N BLUFF ST STE 550
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City | ST GEORGE
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State | UT
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Zip | 84770
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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 STE 550
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City | ST GEORGE
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State | UT
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Zip | 84770-5775
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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 |
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Name |
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Credential |
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Telephone |
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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 | S3-248
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9366743-9921
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License Number State | UT
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