Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5898951-9921 | UT |
NPI | 1053478420 |
---|---|
Provider Name | Dr. Brice William Beckstrom |
First Address | St George, UT 84770-4894 |
Second Address | St George, UT 84770-4894 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |