Healthcare Provider Details

I. General information

NPI: 1992619019
Provider Name (Legal Business Name): AURELINE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7714 W 159TH ST
ORLAND PARK IL
60462-5445
US

IV. Provider business mailing address

7714 W 159TH ST
ORLAND PARK IL
60462-5445
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: AYA M IHMOUD
Title or Position: OWNER
Credential: DDS
Phone: 708-374-1494