MEDICARE: BRIAN L. O'BYRN DDS, MS, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		IL

General Provider Information

NPI Number	:	1265569719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN L. O'BYRN DDS, MS, LTD.

Provider Business Mailing Address
First Line	:	49 W ACORN LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-4804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 W ACORN LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-4804
Country	:	US
Telephone Number	:	847-854-0016
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN L. O'BYRN
Credential	:	D.D.S.
Telephone Number	:	847-854-0016

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/22/2020

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