Healthcare Provider Details

I. General information

NPI: 1891927778
Provider Name (Legal Business Name): DR GERARD AYLWARD ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PLUM GROVE ROAD STE 2
PALATINE IL
60067
US

IV. Provider business mailing address

710 BRAEBURN RD
INVERNESS IL
60067-4224
US

V. Phone/Fax

Practice location:
  • Phone: 847-721-5061
  • Fax: 847-359-3012
Mailing address:
  • Phone: 847-358-9000
  • Fax: 847-359-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021001218
License Number StateIL

VIII. Authorized Official

Name: DR. GERARD AYLWARD
Title or Position: ORTHODONTIST
Credential: BDS, MS
Phone: 708-456-5454