| NPI | 1174057319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN BECKSTROM President/Orthodontist 435-628-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 93667439921) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2017-04-14 |