Provider Demographics
NPI:1053478420
Name:BECKSTROM, BRICE WILLIAM (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BRICE
Middle Name:WILLIAM
Last Name:BECKSTROM
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Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:1091 N BLUFF ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4894
Mailing Address - Country:US
Mailing Address - Phone:435-628-6200
Mailing Address - Fax:435-652-9051
Practice Address - Street 1:1091 N BLUFF ST
Practice Address - Street 2:SUITE 550
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4894
Practice Address - Country:US
Practice Address - Phone:435-628-6200
Practice Address - Fax:435-652-9051
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5898951-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics