Provider Demographics
NPI:1023037694
Name:PENNINGTON, ERNEST N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:N
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2904
Mailing Address - Country:US
Mailing Address - Phone:304-344-0344
Mailing Address - Fax:304-344-0354
Practice Address - Street 1:111 BROOKS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2904
Practice Address - Country:US
Practice Address - Phone:304-344-0344
Practice Address - Fax:304-344-0354
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice