Provider Demographics
NPI:1255495081
Name:AYLWARD, GERARD (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
Last Name:AYLWARD
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 W NORTH AVE
Mailing Address - Street 2:2A
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4252
Mailing Address - Country:US
Mailing Address - Phone:708-456-5454
Mailing Address - Fax:708-456-5497
Practice Address - Street 1:7310 W NORTH AVE
Practice Address - Street 2:2A
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4252
Practice Address - Country:US
Practice Address - Phone:708-456-5454
Practice Address - Fax:708-456-5497
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics