Healthcare Provider Details

I. General information

NPI: 1679437321
Provider Name (Legal Business Name): ROLLIN SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WENLOCK PL
ROCKTON IL
61072-3301
US

IV. Provider business mailing address

110 WENLOCK PL
ROCKTON IL
61072-3301
US

V. Phone/Fax

Practice location:
  • Phone: 708-543-0089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MAHMOUD SALAMEH
Title or Position: DENTIST
Credential: DMD
Phone: 708-543-0089