# BROOKFIELD ORAL SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Brookfield Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225612534
- **Authorized official:** DR. TYRAN E JOHNSON DDS (OWNER)
- **Authorized official phone:** (708) 680-7017

## Contact information

- **Practice address:** 9240 BROADWAY AVE, BROOKFIELD, IL 60513-1252
- **Practice address phone:** (708) 680-7017
- **Practice address fax:** (708) 419-3537
- **Mailing address:** 27 ELMWOOD AVE, LA GRANGE PARK, IL 60526-2032
- **Mailing address phone:** (708) 680-7017

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 05/12/2021
- **Last updated:** 05/12/2021