Healthcare Provider Details

I. General information

NPI: 1902739980
Provider Name (Legal Business Name): ROLLA NAIM KATTOUM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N LARKIN AVE STE 504
CREST HILL IL
60403-1894
US

IV. Provider business mailing address

1701 N LARKIN AVE STE 504
CREST HILL IL
60403-1894
US

V. Phone/Fax

Practice location:
  • Phone: 847-532-5252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037123
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: