Healthcare Provider Details

I. General information

NPI: 1760224190
Provider Name (Legal Business Name): AYA IHMOUD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10741 165TH ST
ORLAND PARK IL
60467-8713
US

IV. Provider business mailing address

9807 W SOMERSET LN
PALOS PARK IL
60464-1578
US

V. Phone/Fax

Practice location:
  • Phone: 708-374-1494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019036275
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: