| Brookfield Oral Surgery, Llc | |
|
9240 Broadway Ave Brookfield IL 60513-1252 | |
| (708) 680-7017 | |
| (708) 419-3537 |
| Full Name | Brookfield Oral Surgery, Llc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 9240 Broadway Ave, Brookfield, Illinois |
| Authorized Official Name and Position | Tyran E Johnson (OWNER) |
| Authorized Official Contact | 7086807017 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brookfield Oral Surgery, Llc 27 Elmwood Ave La Grange Park IL 60526-2032 Ph: (708) 680-7017 | Brookfield Oral Surgery, Llc 9240 Broadway Ave Brookfield IL 60513-1252 Ph: (708) 680-7017 |
| NPI Number | 1225612534 |
|---|---|
| Provider Enumeration Date | 05/12/2021 |
| Last Update Date | 05/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225612534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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