Individual provider Active NPI

Ryan Johnson, DMD

  • Periodontics
  • Oak Brook, IL
National Provider Identifier
1447924808
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
021.003528 Issued in IL
Practice address
120 Oakbrook Ctr Ste 714
Oak Brook, IL 60523-1831
Phone
(630) 654-3331
Fax
(630) 954-2910
NPI assigned
Aug 9, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 021.003528 IL Primary

Addresses

Primary practice location

120 Oakbrook Ctr Ste 714
Oak Brook, IL 60523-1831

Mailing address

958 Kensington Dr
Northbrook, IL 60062-5975
Phone (941) 914-5056

Other practice location 1

23909 W Renwick Rd Ste 103
Plainfield, IL 60544-2109
Phone (815) 609-3636

Other practice location 2

1641 N Milwaukee Ave Ste 3
Libertyville, IL 60048-1386
Phone (847) 349-4306

Other practice location 3

720 Brom Ct Ste 102
Naperville, IL 60540-6533
Phone (630) 717-6717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
13966CTMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oakbrook Endodontic Associates, LTD. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1447924808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "958 KENSINGTON DR",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600625975",
            "telephone_number": "941-914-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 OAKBROOK CTR STE 714",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231831",
            "telephone_number": "630-654-3331",
            "fax_number": "630-954-2910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23909 W Renwick Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Plainfield",
            "state": "IL",
            "postal_code": "605442109",
            "country_code": "US",
            "telephone_number": "815-609-3636",
            "fax_number": "815-609-3399",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1641 N Milwaukee Ave Ste 3",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600481386",
            "country_code": "US",
            "telephone_number": "847-349-4306",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 Brom Ct Ste 102",
            "address_purpose": "LOCATION",
            "city": "Naperville",
            "state": "IL",
            "postal_code": "605406533",
            "country_code": "US",
            "telephone_number": "630-717-6717",
            "fax_number": "630-717-7790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RYAN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-09",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021.003528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Brook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2026; 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.