Provider Demographics
NPI:1235601659
Name:BURKE AND BECKSTROM ORTHODONTICS
Entity Type:Organization
Organization Name:BURKE AND BECKSTROM ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BECKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:435-628-6200
Mailing Address - Street 1:1100 CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5671
Mailing Address - Country:US
Mailing Address - Phone:435-628-6200
Mailing Address - Fax:
Practice Address - Street 1:446 S MALL DR STE 100
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4944
Practice Address - Country:US
Practice Address - Phone:435-673-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S3-248OtherNEVADA DENTAL LICENSE-BRIAN L. BECKSTROM
UT7598338-9921OtherUTAH DENTAL LICENSE-BRANDON G. BURKE
1396035416OtherINDIVIDUAL NPI-BRIAN L. BECKSTROM
UT9366743-9921OtherUTAH DENTAL LICENSE-BRIAN L. BECKSTROM
NVS3-216COtherNEVADA DENTAL LICENSE-BRANDON G. BURKE
1215249982OtherINDIVIDUAL NPI-BRANDON G. BURKE