Provider Demographics
NPI:1760879126
Name:BROTHERS, JOHN (DDS, MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BROTHERS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 W 242ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6566
Mailing Address - Country:US
Mailing Address - Phone:310-373-7773
Mailing Address - Fax:310-373-7771
Practice Address - Street 1:3771 W 242ND ST STE 102
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6566
Practice Address - Country:US
Practice Address - Phone:310-373-7773
Practice Address - Fax:310-373-7771
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175649204E00000X
CA1047471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery