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Organization
BROOKFIELD ORAL SURGERY, LLC
Active
Organization
BROOKFIELD ORAL SURGERY, LLC
Active
Other names
Brookfield Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYRAN E JOHNSON DDS (OWNER)
(708) 680-7017
Entity
Organization
Contact information
Practice address
9240 BROADWAY AVE, BROOKFIELD, IL 60513-1252
(708) 680-7017
(708) 419-3537
Mailing address
27 ELMWOOD AVE, LA GRANGE PARK, IL 60526-2032
(708) 680-7017
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
05/12/2021
Last updated
05/12/2021
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