Brookfield Oral Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

BROOKFIELD ORAL SURGERY, LLC

Doing business as

Brookfield Oral Surgery

Practice address

9240 Broadway Ave
Brookfield, IL 60513-1252

Phone

(708) 680-7017

Fax

(708) 419-3537

NPI assigned

May 12, 2021

Last updated

May 12, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tyran E Johnson, DDSNPI 1770671414

Title

Owner

Phone

(708) 680-7017

Specialties & licenses 1

Addresses

Other names 1

• Brookfield Oral Surgery Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tyran Eric Johnson, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Brookfield, IL
  • NPI 1770671414
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1225612534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 ELMWOOD AVE",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605262032",
            "telephone_number": "708-680-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9240 BROADWAY AVE",
            "city": "BROOKFIELD",
            "state": "IL",
            "postal_code": "605131252",
            "telephone_number": "708-680-7017",
            "fax_number": "708-419-3537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKFIELD ORAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TYRAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-680-7017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookfield Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brianne Bolin, M.S. CCC-SLP/L
• Catherine Marie Bradley
• Nicholas Bravo, PHARMD
• British Home for Retired Men and Women (The British Home)
• Brookfield Dental Studio PC
• Brookfield Smiles Inc.
• Adrian Marcus Cardenas, LCSW
• Jennifer J Carrino, B.S.E.D.D.T
• CC Wellness Solutions, LLC
• Anneliese Victoria Cervantes, PTA

• Oral and Maxillofacial Surgery (Dentist) in Brookfield, IL
• Providers in Brookfield, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.