Provider Demographics
NPI:1932988458
Name:ROCKFORD DENTAL LOUNGE INC
Entity Type:Organization
Organization Name:ROCKFORD DENTAL LOUNGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RABEH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SALAMAH-MOHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-543-6143
Mailing Address - Street 1:4312 E STATE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4312 E STATE ST STE 1
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2144
Practice Address - Country:US
Practice Address - Phone:773-865-2859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental